- Sac excised leaving 2-3cm margin then everted and sutured behind cord
- Incision over the anterior aspect of hydrocele parallel to Median raphe made with back of blade between any visible vessels.
- Dissect through skin, Dartos, external spermatic fascia, Cremasteric fascia, internal spermatic fascia.
- Bluntly dissect in the plane between internal spermatic fascia and parietal layer of tunica vaginalis. Complete dissection using fingers and deliver the hydrocele intact from the scrotum.
- The hydrocele fluid is drained by a simple stab incision and collected in a bowl. A sample is sent for cytology, microscopy and culture.
- Place two artery forceps on the edges of sac and split the tunica vaginalis to expose the testis taking care not to damage testis or epididymis
- The parietal layer of the tunica vaginalis is trimmed as required everted and wrapped around the testis and sutured to itself around the back of testis and cord using 2/0 Vicryl –Achieve perfect haemostasis of tunica, edges of scrotum.
- Return the testis to the sac created.
- Close the dartos layer using interrupted 2/0 Vicryl and place a silastic corrugated drain into the sac created by blunt dissection
- Close skin 3/0 monocryl