The cutting operations include the open method and removal of the parietal layer of the sac. In the former the tis sues of the scrotum and sac are incised, the sac sutured to the skin to prevent adhesions, and the cavity of the tunica vaginalis packed with iodoform gauze to promote healing from the bottom. In the latter the parietal layer of the sac is removed through an incision of suffi cient' length, and the wound closed. These methods are preferable when the iodine method has failed or when the wall of the sac is thick.
Nineteen hydroceles perfectly cured by slitting up the scrotum and tunica vagi nalis by an incision an inch long, stitch ing the tuniea vaginalis to the scrotum, and applying an antiseptic dressing.
Cavity was not injected nor interfered with in any way. Lieutenant-Colonel Hall (Brit. Mal. Jour., Apr. S, '93).
The principle of inversion, or eversion of the tnnica vaginalis, differs absolutely from that of total excision: instead of removing the serosa, it is retained and turned inside out, thus destroying the secreting serous sac. The secreting sur face becomes external, and the secretion is absorbed as it forms. The operation of inversion of the tunica vaginalis is performed as follows: Under local or general amesthesia an incision is made clown to the fibro-serous layer. The length of the incision varies necessarily with the dimensions and position of the hydrocele. The tumor, still unopened, is then dissected by means of gauze or the finger until the mass is free from the cellular layer, especially posteriorly. All bleeding must be checked at this stage by hremostats or ligatures. A long in cision is then made in the sac, from which the liquid escapes. The tunica is then turned inside out, placing the endo thelial surface outward, and securing the cut edges of the serosa as high as pos sible around the cord by means of two or three catgut sutures. The testicle is then replaced in its normal position. It is covered by the skin, dartos, and cellular tissue. Suture of the skin with out drainage completes the operation, which requires generally from five to ten minutes.
A very mild local reaction, and, excep tionally, some tenderness over the tes ticle, may be noted during the first two or three days. Dudley Tait (Annals of
Slug., Mar., 1901).
Review of three hundred and thirty eight operations. The injection method proved the most unsatisfactory. That devised by Doyen (1S95), and recom mended by Winkelman (1S9S), proved the best. It is performed under local anaesthesia as follows:— The ordinary incision is made through the scrotal tissue down to the tunica vaginalis. An opening is then made in the upper portion of the sac in the vicinity of the cord, through which the testicle is drawn after the fluid is evacu ated; then the tuniea vaginalis propria is everted. To prevent the testicle from slipping back into the sac, the upper part of the tunica vaginalis is secured by means of fine catgut sutures to the fascia of the cord, a suture being placed at the same time at the lower end of the tunic, anchoring it in its new pos'ition and preventing the return of the testicle to its former position. The testicle, to gether with the inverted sac, is then replaced within the scrotum and the wound closed by interrupted sutures. The time needed for the operation is less than ten minutes. It is not attended by haemorrhage. and no ligatures are needed. The operation was first per formed in this country by IV. W. Keen. In large hydroceles of long standing, with thickened sacs, the operation is not practicable. In these resection must be employed, as it is impog.ible to invert the tunic. In all cases operated upon by eversion a painless enlargement of the testicle resulted, not attended by rise of temperature, the enlargement sub siding at the end of ten days. Orville Horwitz (Therap. Gaz.. Apr. 15, 1901).
Series of nineteen cases of hydrocele treated by AVinkelmann's operation. Local anaesthesia was employed in all but one case, in which a hernia was also operated by Bassini's method. The re sults were excellent in every ease. Ohl (Deutsche Archly f. Chir., :May, 1001).
Congenital cases can occasionally be cured by the application of a truss. If this fails, an antiseptic seton will usually prove successful.
Spermatocele.—A collection of milky fluid in the tunica vaginalis containing spermatozoa gives rise to symptoms simi lar to hydrocele. The treatment is the same as that for the latter disorder.