The Western snip, stitch, and tug hydrocelectomy: How I do it

INTRODUCTION: Adult idiopathic hydrocele is a common benign disorder that merits surgical correction when symptomatic. The most popular techniques for repair are plication (Lord's procedure) or excision and eversion of the tunica vaginalis (Jaboulay procedure). Established complications from these traditional repairs include hematoma, recurrence, and infection. These procedures are performed through a scrotal incision. We describe a novel technique of hydrocele repair with gubernaculum preservation through a subinguinal incision. METHODS: The novel technique is described in detail. A retrospective review was performed of those patients treated by a single surgeon with the subinguinal technique. Demographic information, indication for treatment, success rate, and details regarding complications were collected. RESULTS: We term the technique the "Snip, Stitch & Tug" repair. Through a small subinguinal incision, the tunica is everted posterior to the spermatic cord and testis without resection of the hydrocele sac or division of the gubernaculum. Twelve patients with postoperative followup were identified. Eleven patients (92%) treated with the novel technique were cured. There was only one complication (superficial wound infection) recorded after this technique. CONCLUSIONS: Idiopathic hydrocele repair with gubernaculum preservation can be easily and safely performed through a small subinguinal incision.