Jaboulay's versus harmonic scalpel hydrocelectomy: prospective randomized controlled study

Surgical procedures for vaginal hydroceles have been varied with the aims of preventing recurrence, hematoma and edema formation and providing a better cosmetic outcome. The Jaboulay's procedure remains a preferred procedure owing to its simplicity and good long term outcome. However, sac eversion during the procedure leads to scrotal edema and mass sensation due to remnant sac in cases of large or secondary hydrocele sacs. Sac excision in these cases may provide better outcomes by removing the excess tissue. We aimed to compare the postoperative outcome after Jaboulay's procedure and harmonic scalpel excision of the sac in terms of scrotal edema, hematoma formation and the final cosmetic appearance.

72 adult patients with vaginal hydrocele were randomized into two groups, who underwent harmonic scalpel sac excision and Jaboulay's procedure respectively, performed by a single surgeon. Preoperatively, patient demographics were noted. Postoperatively, data was recorded on the 1st day, 3rd day & 10th day about postoperative complications, and outcomes. Satisfaction on final cosmetic outcome was compared between the groups at the 3rd month.

Post operative edema and sensation of mass in the scrotum were more (but not significant) in the Jaboulay's procedure group. Seroma and wound infection rates were similar in both groups. Patient satisfaction on cosmesis was better in the sac excision group.

Hydrocelectomy with excision of the sac using a harmonic scalpel results in a lower incidence of postoperative oedema and better patient satisfaction in terms of cosmetic outcome compared to Jaboulay's procedure in the treatment of adult hydroceles.