Bloodless operation for a giant hydrocele.

A new hydrocele eversion technique designed for treating giant hydroceles (fluid content over 3 L) is described. The technique takes advantage of the existence of an avascular, loose areolar plane between the external and internal spermatic fascia within which a subdartos-cremasteric pouch is developed. The hydrocele fluid is drained through a trochar and cannula, and the tunica vaginalis is everted and then quilted with 2/0 chromic catgut. The testis and the quilted tunica are placed in the subdartos-cremasteric pouch and the incision is closed. The quilting of the tunica vaginalis not only prevents reinversion of the sac, but, together with the tight fit of the pouch around the sac, it also reduces the potential space into which postoperative seroma can accumulate.This technique is particularly useful when fibrous adhesions develop between the tunica vaginalis and the subjacent spermatic fascia in giant hydroceles. No drains or external pressure dressing are required, and the technique has been used in 14 giant hydroceles with no complications or recurrence.