OT notes · General Surgery

Hydrocele repair (Jaboulay eversion / Lord's plication)

Usual anaesthesia
Spinal; local cord block in selected patients
Position
Supine
Setting
elective

Operative note template for scrotal surgery for a primary vaginal hydrocele (Lord's plication, eversion, Jaboulay or subtotal excision of the sac), with a filled example for a large right hydrocele treated by partial excision and eversion (Jaboulay).

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Blank template

Follow this order in the case sheet. Tick the options that apply and fill the blanks.

Patient and case

  1. Name / Age / Sex
  2. UHID / IP no. / Ward-Bed
  3. Date of surgery / OT no.
  4. CaseElectiveEmergency (non-elective)if emergency, state urgency and reason
  5. Timesin OT ___ anaesthesia start ___ incision ___ closure ___ out of OT ___

Team

  1. Operating surgeonname, designation
  2. Assistant(s)
  3. Supervising consultantpresent in OT / available / not applicable
  4. Steps done by the residentwhole procedure / named steps, under whose supervision
  5. Anaesthetist
  6. Scrub nurse / circulating nurse

Diagnosis and procedure

  1. Pre-operative diagnosis
  2. Post-operative diagnosis
  3. Procedure planned
  4. Procedure performedif different from plan, state why
  5. Extra procedure done and reason'none' if none. Only to save life or health if not consented

Consent and safety checks

  1. Informed consentGeneralProcedure-specificHigh-riskAnaesthesiain a language the patient understands: language ___ witness ___
  2. Site / side markedYesNot applicable
  3. WHO Surgical Safety ChecklistSign inTime outSign out
  4. Antibiotic prophylaxisdrug, dose, route, time given before incision
  5. VTE prophylaxisMechanicalPharmacologicalNot indicated

Risks to explain in the consent for this operation

  • scrotal haematoma, which may need re-exploration
  • wound infection and pyocele
  • scrotal swelling for some weeks
  • recurrence
  • persistent discharging sinus
  • injury to the testicular vessels, epididymis or vas with testicular atrophy
  • orchidectomy if the testis is found destroyed (separate consent)

Pre-operative details for this operation

  1. SideRightLeftBilateralside marked
  2. Clinical findingssize, transillumination, get above the swelling, testis palpable or not
  3. Scrotal ultrasoundtestis and epididymis normal / abnormal; tumour excluded; any hernia
  4. Type suspectedPrimary vaginalEncysted hydrocele of cordInfected / pyoceleHaematoceleFilarial / chylocele
  5. Consent for orchidectomy if neededTakenNot required

Anaesthesia and position

  1. AnaesthesiaSpinalLocal (cord block)General
  2. PositionSupine
  3. Skin preparationantiseptic; scrotum and penis draped out

Operative findings

  1. Fluidvolume in ml and colour: clear straw / turbid / blood-stained / chylous / pus
  2. SacThinThickCalcifiedMultiloculated
  3. TestisNormal size and consistencyAtrophicSuspicious nodule
  4. Epididymis and cordnormal / thickened / cyst
  5. Hernia sac at the rootNonePresent

Procedure (steps)

  1. IncisionVertical anterior scrotal, lateral to rapheMedian raphe (bilateral)Inguinallength in cm
  2. Layers dividedskin, dartos, external and internal spermatic fascia; bluish sac seen
  3. Fluid evacuatedTrocar and cannulaIncision into sacvolume
  4. Sac opened in an area away from testis and epididymis
  5. Testis, epididymis and cord inspectedbiopsy of any suspicious area
  6. Procedure on sacLord's plicationEversion without excisionPartial excision and eversion (Jaboulay)Subtotal excision (hydrocelectomy)reason for choice: sac thin / thick, size
  7. Suture on sacmaterial and size; plication stitches number; eversion edges continuous suture behind testis, loose at top for cord
  8. Haemostasis of cut sac edgeBipolarFine ligaturesOversewn with running lock stitch
  9. Testis returned to scrotum without twisting

Closure, drains and dressing

  1. DrainNoneCorrugated drainSuction drainexit through dependent lateral part of scrotum
  2. Dartosabsorbable suture, or closed with skin in one layer
  3. Skininterrupted non-absorbable monofilament; material and size
  4. Dressing and scrotal supportScrotal support applied

Specimens and implants

  1. Excised sac for HPESentNot sent (Lord's / eversion only)
  2. FluidSent for culture / cytology / chyleNot sent
  3. Testicular biopsy (if any)site, frozen section result

End of procedure

  1. Estimated blood lossml
  2. IV fluids and blood / products givenfluids (ml); blood: type, units, bag nos.
  3. Swab, needle and instrument countCorrectIncorrect: action taken
  4. Intra-operative complications / difficultieswhat happened and what was done; 'none' if none
  5. Implant stickersNo implantAffixed in case sheet, OT register and for discharge summary
  6. Condition at end of surgery / shifted toPACUWardICU/HDU

Post-operative orders

  1. Scrotal supportkeep on to reduce swelling and pain
  2. Watch for scrotal haematomaincreasing swelling, pain, bleeding through dressing; inform surgeon
  3. Drainchart output; usual removal at 48 hours
  4. Oral intakeliquids after spinal wears off, then normal diet
  5. Mobilisationsame day or next morning with scrotal support
  6. Woundlook for redness, discharge, fever
  7. Suture removal and follow-update and clinic

Signature

  1. Name and designation of person writing note
  2. Medical Council registration no.
  3. Signature / date / time of writingwrite before the patient leaves recovery

Worked example

Fictional case: Mr. R.M., 58 years, with a painless right scrotal swelling for 4 years, brilliantly transilluminant, testis not separately palpable. Scrotal ultrasound shows a large right vaginal hydrocele with a normal testis and epididymis.

Case details

Date: 10/03/2026. Elective. OT 4.

In OT 11:30. Spinal given 11:40. Skin incision 11:55. Closure completed 12:35.

Surgeon: Dr A. (2nd-year resident, General Surgery). Assistant: Dr B. (1st-year resident). Consultant: Dr C., in OT complex.

Anaesthetist: Dr D. Scrub nurse: Sr E.

Indication and pre-op

Indication: large right primary vaginal hydrocele, causing discomfort while walking and sitting.

USG scrotum: right hydrocele, testis 4.2 x 2.6 cm with normal echotexture, epididymis normal, no hernia. Left side normal.

Side marked on the right. Consent: general, procedure-specific (including orchidectomy if testis found destroyed) and anaesthesia consent taken in Hindi from patient, wife as witness.

WHO checklist sign in and time out done. Inj cefazolin 2 g IV at 11:45, 10 min before skin incision.

Anaesthesia and position

Spinal anaesthesia. Supine. Parts painted with povidone-iodine and draped, scrotum exposed.

Procedure

Vertical incision of 6 cm on the anterior right hemiscrotum, 1 cm lateral to the median raphe.

Skin, dartos, external and internal spermatic fascia divided. Bluish hydrocele sac seen.

Fluid drained with trocar and cannula: about 400 ml clear straw-coloured fluid.

Sac opened anteriorly, away from the testis and epididymis.

Findings: sac thin at places but redundant. Testis normal size and consistency, no nodule. Epididymis and cord normal. No hernia sac at the root.

Redundant sac partly excised, leaving a cuff of about 1 finger-breadth around the testis. Remaining sac everted behind the testis and the edges sutured to each other with continuous polyglactin 910 (Vicryl) 3-0, leaving the top loose for the cord (Jaboulay).

Bleeders on the cut sac edge controlled with bipolar cautery.

Testis returned to the scrotum in normal lie, without twisting.

Closure

Corrugated drain placed through a separate stab at the lower lateral part of the right hemiscrotum.

Dartos closed with absorbable Vicryl. Skin closed with interrupted non-absorbable monofilament sutures.

Dressing applied and scrotal support given.

Specimens and implants

Excised part of the sac in formalin, sent for HPE. Fluid not sent. No implants.

End of procedure

Estimated blood loss 20 ml. No transfusion.

Mop, needle and instrument count correct, confirmed by scrub nurse.

No intra-operative complications.

Shifted to post-operative ward in stable condition. Pulse 78/min, BP 130/84 mmHg.

Post-op orders

Pulse, BP half-hourly for 2 hours, then 4-hourly.

Oral liquids after 4 hours, then normal diet.

Analgesia as per ward protocol.

Scrotal support at all times. Mobilise in the evening.

Check dressing for soakage and scrotum for rising swelling every 4 hours tonight.

Drain output charted; plan removal at 48 hours.

Suture removal and review in surgery OPD on POD 8.

Signature

Dr A., JR-2, General Surgery. Reg. no. ________. 10/03/2026, 12:50.

Must document for this operation

  • Side operated, with side marking done before anaesthesia. Operating on the wrong side is an avoidable error, so the note must show the side was confirmed before incision.
  • Which procedure was done on the sac (Lord's, eversion, Jaboulay, subtotal excision) and why. If the hydrocele comes back, the next surgeon needs to know how much sac was left.
  • Volume and colour of the fluid. Blood-stained, turbid or chylous fluid points to another cause and changes follow-up.
  • Appearance of the testis and epididymis, and any biopsy. A testicular tumour can present as a hydrocele, so a normal testis must be recorded.
  • Drain type and exit site, and scrotal support ordered. Scrotal haematoma is the common complication and nurses need to know what to watch.

Common mistakes in these notes

  • Writing 'hydrocele operated' with no mention of which operation was done on the sac.
  • Not recording the side in the procedure heading.
  • Leaving out the state of the testis.
  • Not sending a thick or abnormal sac for histopathology (HPE).
  • Forgetting to note the drain, so it is not charted or removed on time.

Sources

  • Bhat SR. SRB's Surgical Operations: Text and Atlas. Jaypee; 2014, Ch 31, Surgeries of Penis, Scrotum and Testis: Hydrocele (procedure, Lord's plication, eversion, subtotal excision, Jaboulay, complications), pp. 1209-1213.
  • Scott-Conner CEH, Dawson DL, eds. Scott-Conner & Dawson: Essential Operative Techniques and Anatomy. 4th ed. Wolters Kluwer; 2015, Ch 117, Hydrocelectomy, Orchiectomy, pp. 631-634.
  • Bratzler DW, et al. ASHP/IDSA/SIS/SHEA Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm 2013;70:195-283. Table 1 (cefazolin 2 g adult), Table 2 urologic procedures, clean without entry into urinary tract: cefazolin, within 60 min before incision. www.ashp.org/-/media/assets/policy-guidelines/docs/therapeutic-guidelines/therapeutic-guidelines-antimicrobial-prophylaxis-surgery.pdf

Educational template for residents. Adapt it to your institution's case-sheet format and your consultant's instructions. Patient details in the example are fictional.

Videos of this operation

Teaching videos and pages for this operation, listed under the curriculum item that asks for it.

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