Assessment of fenestration of the tunica vaginalis testis during palomo varicocelectomy in adolescent boys for the prevention of postoperative hydrocele

Palomo varicocelectomy is widely accepted as the preferred treatment of primary varicocele in childhood. However, there is a high incidence [up to 33%] of postoperative hydrocele following this procedure. It is frequently nuisant and reaches a considerable size that necessitates surgical intervention for cure. Many procedures have been examined for the prevention of such complication. However, we evaluated one of these procedures, namely the technique of simultaneously incising the ipsilateral tunica vaginalis testis with the Palomo varicocelectomy. Forty-five patients were included in this study. They were subdivided into two subgroups. The first one was subjected to only Palomo varicocelectomy while the second to Palomo procedure in addition to ipsilateral incision of the tunica vaginalis. None of the patients of the second subgroup developed a postoperative hydrocele. Incising the tunica vaginalis adds no morbidity to the varicocelectomy. It is rather safe and simple technique that proved effective in the prevention of postoperative hydrocele after Palomo procedure

Interval appendectomy after initial conservative management of appendicular mass: Should the asymptomatic patient have Surgery?

25 patients [mean age 28 years] presented with a clinical and radiological diagnosis of appendicular mass were prospectively studied. Management was by initial conservative treatment followed by appendectomy only for those who develop recurrent acute appendicitis or continue complaining of symptoms consistent with chronic appendicitis. During the initial conservative treatment, all patients received antibiotics against aerobes and anaerobes for a mean of 8.6 days and intravenous fluids for a mean of 4.2 days. Incision and drainage without appendectomy was indicated in three patients [12 percent] who developed appendicular abscess. The mean hospital stay was 8.2 days. Patients were followed up for a mean of 31 [range 24-36] months after discharge. During the follow-up period, 22 patients [88 percent] remained well, 2 patients [8 percent] developed recurrent acute appendicitis for which emergency appendectomy was performed, and 1 patient [4 percent] required elective appendectomy for chronic appendicitis. The conditions of the patients during the period of conservative management could not predict for whom appendectomy would be indicated later. By following this approach, the morbidity, mortality and cost of routine interval appendectomy were thus eliminated in 88 percent of the patients