Testis Epididymis and Scrotum

The scrotum can pose a problem for postoperative haematomas following hydrocoele surgery, due to the high vascularity of the tunica and its own dependent nature. The ability of the scrotum to stretch, prevents tamponading of the vessels. While it cannot be stressed enough that there is no substitute for meticulous dissection and haemostasis after dissecting the hydrocoele sac, the incidence of bleeding may be reduced by the postoperative use of a well-fitted scrotal support. If Jaboulay's procedure is performed, the cut edges should be over sewn with locking sutures for haemostasis and, then, tacked posterior to the testis. Lords procedure was described in 1964 as an improvement over existing procedures. It reduces the incidence of haematomas by avoiding excision of the vascular sac of the tunica vaginalis. This procedure consists of using radial sutures to gather the sac around the posterior aspect of the testis and the epididymis. Twenty-two consecutive cases were reported without haematomas.71 Unfortunately, the disadvantage is a rather bulky feeling testis, afterwards. Various methods have been tried to prevent haematomas, including scrotal suspension using a hypogastric suture, as published by one group.72

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