General Surgery

Herniorrhaphy (Hernioplasty, Hernia repair) is a surgical procedure for correcting hernia. A hernia is a bulging of internal organs or tissues, which protrude through an abnormal opening in the muscle wall. Hernias can occur in the abdomen, groin, and at the site of a previous surgery.

Almost all repairs done today are open "tension-free" repairs that involve the placement of a synthetic mesh to strengthen the inguinal region; some popular techniques include the Lichtenstein repair (flat mesh patch placed on top of the defect), Plug and Patch (mesh plug placed in the defect and covered by a Lichtenstein-type patch), Kugel (mesh device placed behind the defect), and Prolene Hernia System (2-layer mesh device placed over and behind the defect). This operation is called a 'hernioplasty'

In recent years, as in other areas of surgery, laparoscopic repair of inguinal hernia has emerged as an option. "Lap" repairs are also tension-free, although the mesh is placed within the pre-peritoneal space behind the defect as opposed to in or over it. It has no proven superiority to the open method other than a faster recovery time and a slightly lower post-operative pain score. Unlike the open method, laparoscopic surgery requires general anesthesia. It is usually more expensive and consumes more Operating Room time than open repair, carries a higher risk of complications, and has equivalent or higher rates of recurrence compared to the open tension-free repairs.

Hydrocelectomy is a surgical procedure to remove a hydrocele. A hydrocele is collected fluid in the membrane surrounding the testes.

Hydrocelectomy is performed to relieve the pain or reoccurrence of a hydrocele. Normally, hydroceles are not very painful. They tend to be a soft swelling in the membrane surrounding the testes. As the hydrocele grows, the scrotum gets larger. Hydroceles do not damage the testes. The main symptom is scrotal swelling. There are two types of hydroceles depending on how they form. One type is seen in children, generally shortly after birth. It is caused by a failure of the processus vaginalis to close. Usually, surgery is not used to treat hydrocele until after two years of age because the processus vaginalis frequently closes by itself if given extra time. In adults, hydroceles develop slowly. Most hydroceles develop because of blocked lymphatic flow. Hydroceles also develop after infection, injury, or local cancer tumors. Generally, hydroceles are treated by aspiration of the collected fluid. To do this, a needle is inserted into the scrotum and directed toward the hydrocele. Once there, as much fluid as possible is removed. Hydroceles can reoccur. Rarely, hydroceles grow larger and cause pain. Surgery is used to remove large or painful hydroceles. It is also the recommended procedure to remove hydroceles that reoccur after aspiration. Hydroceles are distinguished from other testicular problems by transillumination and scrotal ultrasound examinations.

Two techniques are effective treatments for hydroceles.

The first technique, plication of the sac (Lord procedure) is used for small to medium hydroceles. The benefits of this technique are reduced risk of hematoma (localized collection of blood). Some articles suggest a slight incidence of recurrence of the hydrocele following this procedure. The second technique, where the sac is everted and sutured behind the testis (Jaboulay procedure), is associated with a reduced risk of recurrence, but patients may have an increased risk of hematoma.

During surgery, the bulk of the hydrocele sac is cut away, and what remains of the sac is turned inside out. As a result, the fluid-secreting surface is now in contact with the inner skin of the scrotum rather than that of the testicle with which it made previous contact. The scrotal tissue blots up any fluid that is secreted, unlike the testicular tissue that cannot absorb fluid.

Surgical approaches are governed by the size of the hydrocele.