Efficacy of Tunica Vaginalis Eversion during open Varicocelectomy to Minimize Postoperative Hydrocele Versus No Eversion

Abstract

Background: A varicocele is an atypical enlargement and dilatation of the scrotal venous pampiniform plexus, which is responsible for the drainage of blood from each testicle. Although varicoceles are typically asymptomatic, they possess clinical significance due to their high prevalence, which results in anomalous semen analysis, diminished sperm motility, low sperm count, and atypical sperm morphology. Initially, analgesics and scrotal support may be applied to alleviate pain or distress associated with a varicocele. Additionally, it is well-established that varicocele surgery results in the restoration of testicular volumes and semen parameters. The purpose of this study is to compare the outcomes of open varicocelectomy with and without eversion of tunica vaginalis in relation to scrotal oedema, wound infection, postoperative pain, and postoperative hydrocele. Methods: From October 2017 to October 2021, sixty patients between the ages of 18 and 40 who presented with grade IV or V varicocele participated in this study. The patients were divided into two groups, with 30 patients in each: group A underwent open varicocelectomy with tunica vaginalis eversion; and group B underwent open varicocelectomy without tunica vaginalis eversion. The documented complications of the two groups were contrasted. The duration of the operation, the need for postoperative analgesics, the length of hospitalization, the improvement in semen characteristics of subfertile participants, pain assessed using a visual analog scale, and postoperative complications between the two groups were recorded and compared. Results: There was no significant difference in postoperative pain between groups A and B, as measured by a numeric analog scale ranging from 1 to 3 after one and two weeks and from number 2 to 5 in the initial three days. In group A, the duration of the operation varied between 40 and 60 minutes for unilateral cases and 60 to 80 minutes for bilateral cases. In contrast, the duration of the operation varied between 30 and 50 minutes for unilateral cases and 70 to 90 minutes for bilateral cases in group B. In seven patients in group A and three patients in group B, mild scrotal edema resolved within one to three weeks after the procedure. Infection of the lesion was absent in both groups. Similar hospital stays spanning one to three days were observed in both cohorts. A case of mild scrotal hematoma was identified in each cohort; it was treated conservatively without any complications. Postoperative monitoring for hydrocele is conducted for duration of six months in both cohorts. A solitary instance of minimal hydrocele was identified in group A, while four instances of moderate hydrocele were detected in group B. In addition, two cases of moderate hydrocele in group B necessitated surgical intervention due to persistent scrotal pain and symptomatic edema, while the remaining two cases were treated conservatively with follow-up and did not present with pain. Conclusion: In hospitals that perform open varicocelectomy without access to an operating microscope, the eversion of the tunica vaginalis during open varicocelectomy is considered a preventative measure that decreases the incidence of postoperative hydrocele when compared with no eversion, according to the findings of the present study.