The procedure varies based on the hydrocele type and patient age:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Physical exam: Scrotal swelling that transilluminates (light passes through, indicating fluid); non-tender unless infected.
     • Ultrasound confirms the diagnosis, rules out testicular tumor, and checks for hernia.
     • Blood tests assess fitness for surgery (e.g., hemoglobin, coagulation).
   • Blood thinners (e.g., aspirin) are stopped 5–7 days prior to reduce bleeding risk.
   • Patients fast for 6–8 hours before surgery; antibiotics (e.g., cefazolin) may be given prophylactically.
2. Surgical Techniques:
   
   • Open Hydrocelectomy (Most Common):
     
     • Performed under general, spinal, or local anesthesia, lasting 30–60 minutes.
     • A 4–6 cm incision is made over the scrotum (transverse or midline).
     • The hydrocele sac is dissected from surrounding tissues, and the fluid is drained.
     • The sac is either excised (eversion technique) or inverted and sutured (plication technique, e.g., Jaboulay or Lord’s procedure) to prevent recurrence.
     • If a hernia is present (common in children), it is repaired simultaneously (herniorrhaphy).
     • The incision is closed with absorbable sutures; a drain may be placed for 1–2 days to prevent hematoma.
   • Aspiration and Sclerotherapy (Rare):
     
     • Non-surgical alternative for poor surgical candidates.
     • A needle aspirates the fluid, and a sclerosing agent (e.g., tetracycline) is injected to scar the sac and prevent fluid reaccumulation.
     • High recurrence rate (30–50%); not commonly recommended.
   • Laparoscopic Approach (Rare):
     
     • Used for communicating hydroceles in children with a patent processus vaginalis.
     • Small incisions allow closure of the defect at the internal inguinal ring.
3. After Surgery:
   
   • Patients are monitored for a few hours (outpatient) or 1–2 days (if drain placed or complications).
   • Pain is managed with analgesics (e.g., paracetamol, ibuprofen).
   • A scrotal support or tight underwear is worn for 1–2 weeks to reduce swelling.
   • Antibiotics are rarely needed unless infection was present.