Comparative outcomes of minimal-incision versus standard hydrocelectomy: reduced bleeding and healthcare utilization in a multi-surgeon cohort

Background: Hydrocelectomy is one of the most commonly performed benign scrotal procedures, but postoperative complications such as hematoma, infection, and wound-related issues remain common.Minimally invasive approaches to hydrocelectomy may reduce perioperative morbidity and healthcare utilization. Minimally invasive approaches may reduce perioperative morbidity and postoperative healthcare utilization. The minimal-incision modified fenestration technique (MIMFeT), performed under local anesthesia, has not been evaluated in a multi-surgeon, real-world setting. We conducted a retrospective cohort study comparing outcomes of MIMFeT vs. standard hydrocelectomy.

Methods: We retrospectively reviewed 313 patients who underwent hydrocelectomy [2018–2024]. Patients underwent either MIMFeT or standard hydrocelectomy based on surgeon preference. The primary outcome was 30-day postoperative complications (bleeding, infection, and/or reoperation). Secondary outcomes included unplanned postoperative healthcare utilization and recurrence.

Results: Among 313 patients (132 MIMFeT; 181 standard), overall complication rates were lower with MIMFeT (6.1% vs. 13%, P=0.057). Bleeding occurred in 6.1% of standard cases and 0% of MIMFeT cases (P=0.003). Rates of infection and reoperation were similar between groups. Patients undergoing MIMFeT also experienced significantly fewer unplanned postoperative patient contacts, including phone calls, portal messages, and clinic visits (43% vs. 59%, P=0.01). One-year recurrence rates were similar between groups.

Conclusions: When compared to standard hydrocelectomy technique, MIMFeT provides comparable efficacy with elimination of bleeding events and reduced postoperative healthcare utilization. These findings support MIMFeT as a particularly advantageous option for patients at elevated bleeding risk and as a scalable, office-based alternative to standard hydrocelectomy that may improve patient outcomes while reducing healthcare resource utilization.