Jaboulay procedure

Need to exclude testicular tumour first. Do U/S
Aspiration and scrotal approach contra indicated until proven not tumour. Beware hernia can transilluminate as well therefore aspiration again a bad idea.


Grasp scrotum firmly in one hand to stretch scrotal skin.
6-10 cm incision may on anterior surface of scrotum over most prominent part of hydrocoele, well away from testicle which lies posteroinferior.
Skin, dartos and thin cremasteric fascia are incised and reflected back together as a single layer from the underlying parietal layer of the tunica vaginalis which is the outer wall of the hydrocoele.

When hydrocoele well separated laterally and medially from overlying layers, it is grasped with 2 Allis forceps and a trocar is inserted to aspirate the fluid. With one finger inside the sac, dissect it free from the overlying scrotum so that spermatic cord and testicle with attached hydrocoele lie free in operative field.

Hydrocoele sac is then opened completely. Testicle is then carefully inspected and palpated. Redundant wall sac is trimmed leaving a margin of 2cm.

Great care must be taken with haemostasis. Sac is then everted behind testis with interrupted suture.

Close in layers.

Lords procedure:
•Do not deliver the hydorocele out intact b/c less chance of bleeding