Jaboulay’s operation (Eversion of sac)
· Antiseptic dressing and draping.
· Operation is done under local anaesthesia. The spermatic cord is infiltrated with 1% lignocaine hydrochloride. The scrotal skin along the line of incision is also infiltrated with lignocaine hydrochloride.
· A vertical incision is made parallel to the median raphe of the scrotum. The incision is deepened to cut the dartos muscle, the scrotal fascia and the hydrocele sac, lined by the parietal layer of the tunica albuginea is exposed. The tunica vaginalis sac is separated from the dartos muscle layer by finger dissection and a space created between the tunica vaginalis and the dartos. An incision is made over the tunica vaginalis in an avascular area anteriorly away from the testis, epididymis and cord structures and fluid drained. The tunica vaginalis incision is then extended and testis delivered out of the tunica vaginalis sac. The cut margins of the tunica vaginalis sac is everted around the testis and the cut margin is stitched behind the testis with 1-0 chromic catgut sutures. Haemostasis is secured and the testis with the everted sac placed back into the scrotal sac. The dartos muscle is stitched with 1-0 continuous chromic catgut sutures. The skin is sutured with interrupted monofilament polyamide suture. A coconut bandage is then applied. For bilateral hydrocele, the opposite hydrocele may be approached either through the scrotal septum or by a separate incision on the opposite side parallel to the median raphe.