Assessment of the testicular vascularity after inguinal herniotomy in children: a prospective color Doppler study

Abstract

Background Knowing transient vascular perfusion abnormalities of testes after open inguinal herniotomy procedure is essential for the surgeon who is mainly responsible for the patient outcome. Purpose To assess the effect of open inguinal herniotomy procedure on the testicular blood supply in children using duplex ultrasonography (DUS). Material and Methods A prospective observational study included 60 boys (mean age = 9.46 ± 14.46 months; age range = 2 months–6 years) who underwent open inguinal herniotomy operation. Using DUS, the testicular volume, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were calculated preoperatively and one week, one month, and six months postoperatively. The pre- and postoperative measurements were compared. Statistical analysis was performed using χ2 test, Fisher’s exact test, or Student’s t-test when appropriate. Results On physical examination, the hernias were unilateral in 57 boys and bilateral in three boys. Comparison between testicular volumes preoperatively and postoperatively showed no significant change ( P > 0.05). There was a statistically significant increase of PSV and RI one week and one month postoperatively ( P < 0.0001) but returned to be near to the preoperative values at six months. As regards EDV, there was a slight but non-significant postoperative increase ( P > 0.05) which did not return to the preoperative value. Conclusion The affection of testicular vascularity postoperatively is transient and returns to be near to the preoperative values in the late postoperative period (six months postoperatively). Additionally, no significant change in testicular volume postoperatively.

Assessment of testes with two-dimensional Shear Wave Elastography in patients with operated inguinal hernia

“…Some studies have evaluated the effectiveness of IH on testicular perfusion with Doppler US using a resistive index (RI) [15,17]. These studies have shown the testis with IH has a significantly higher RI [18] or that there is no significant difference in the RI values [14,15,[19][20][21]. Studies have also shown that there is no significant alteration of testicular perfusion after IH operation using Doppler US [21,22].…”

Testicular Vascularization after Pediatric Inguinal Hernia Repair: A Systematic Review and Meta-Analysis

“…All studies compared the preoperative values to the postoperative values, either at short-term follow-up (1 day-1 week) or at long-term follow-up (1 month-6 months). Only Palabiyik et al (2009) and Basha et al (2020) reported a statistically significant difference when comparing the preoperative RI to the early follow-up values (p-value = 0.0008 and <0.0001, respectively) [25,27]. These are the two studies that only report RI after an open surgical approach.…”

“…A total of 46 articles were excluded because they did not meet the inclusion criteria. Through a full-text assessment of the remaining articles, nine records were identified that were eligible to be included in the systematic review [25][26][27][28][29][30][31][32][33]. The references of these nine papers were screened, and one additional paper was identified as meeting all inclusion criteria [34].…”

“…All of the included studies were prospective cohort studies, and no randomized controlled trials were found. Two of the included records reported outcomes for both laparoscopy and conventional open surgical approach [28,30], three studies reported the measurements of testicular vascularization after laparoscopic IHR [26,29,33], and five studies described the results after open surgery [25,27,31,32,34]. Of the comparative and non-comparative studies describing laparoscopy, two reported using the percutaneous internal ring suturing (PIRS) [29,30]; in one study, they performed the laparoscopic repair by purse string-suture [26], and in one, they used both purse string-suture and N-suture [28].…”

“…Six of the included studies reported the preoperative and postoperative RI of the centripetal artery [25][26][27][28][29][30]. An overview of the values is given in Table 2.…”