Laparoscopic repair of pediatric inguinal hernia—is vascularity of the testis at risk? A study of 125 testes

Parelkar, Sandesh; Oak, Sanjay; Bachani, Mitesh; Sanghvi, Beejal; Prakash, Avinash; Patil, Rajashekhar; Sahoo, Subrat Kumar; Patel, Jiwanlal

doi:10.1016/j.jpedsurg.2011.05.005

Cited by 13 publications

(13 citation statements)

References 20 publications

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“…In another study, Parelkar et al used CDUS to evaluate 100 patients receiving laparoscopic hernia repair preoperatively, and in early (2 days) and late (6 months) postoperative periods but did not find any significant changes in testicular perfusion 16. Of note was the fact that RI could not be evaluated in 25% of the cases in this previous study, thus clearly demonstrating the problems encountered measuring this parameter.…”

Section: Discussionmentioning

confidence: 65%

“…It is evident that these earlier findings in adult patients contradict the findings of those from children that generally failed to identify testicular damage following inguinal hernia operations 15,16. It appears that it is necessary to follow children who have received inguinal hernia operations for long periods, potentially by annual examination including CDUS evaluation of the testes.…”

Section: Discussionmentioning

confidence: 85%

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A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study

et al. 2017

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Objective:To evaluate the effect of inguinal operations performed with a modified Ferguson technique upon testicular volume and blood flow.Methods:This study involved 23 children receiving surgery for inguinal hernia, hydrocele, and cord cyst. This was a prospective study performed between April 2016 and June 2016 in a medical faculty pediatric surgery unit. The color Doppler ultrasound (CDUS) was used to assess testicular volume and blood flow before and after a modified Ferguson technique surgery. The pre- and post operative testicular volume and blood flow were compared with the contralateral testes. SPSS software was used to statistically analyze the data arising; the Mann-Whitney U test and Friedman test were used to compare samples, and P<0.05 was accepted as statistically significant.Results:Preoperative and postoperative testicular volumes were not statistically different when compared to contralateral testes. In patients with right sided inguinal pathology, testicular blood flow on the right side was significantly lower than that on the left side (P=0.023). The testicular blood flow was not statistically different compared with the contralateral testes during the first week evaluation and first month evaluation. The blood flow, probably reduced due to the pressure caused by inguinal pathology, was normalized through surgery.Conclusions:The modified Ferguson technique do not change the testes volume and blood flow.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 85%

A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study

et al. 2017

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“…There were 100 cases, 75 of whom had a unilateral hernia. The analysis showed that there were no significant differences between preoperative and late postoperative volumes of testis on the operated side [17].…”

Section: Discussionmentioning

confidence: 83%

Analysis of volume change of the testis after inguinal hernia repair using the PIRS method – a prospective pilot study

Wolak,

Piotrowska,

Strzelecka

et al. 2022

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Introduction: Laparoscopic surgery of inguinal hernias in children using the PIRS method is a recognized method of treatment that has been used for several years. Aim of the research:To assess the effects of inguinal hernia repair performed with the percutaneous inguinal ring suturing (PIRS) method on the volume of the testicles. Material and methods: It was a prospective study conducted between January 2016 and December 2019 in the Department of Paediatric Surgery. Twenty-nine male patients aged 0-8 years were included in the study. Ultrasound evaluation of both testicles, comparing the volume before and after inguinal hernia repair, was performed. Results and conclusions:The ultrasound measurements of the testicular volume after the surgical procedure showed no inhibition of growth with the preoperative sonographic examination and concerning the testis of the opposite, non-operated side. The increase in the median of the volume of both testis' was observed in cases before and after the elective surgeries, although there was no statistically significant difference. Emergency operation due to the incarcerated hernia on either side did not statistically significantly affect testicular volume in the tested group of patients. None of the laparoscopically operated patients showed atrophy of the testis. Laparoscopic surgery using the PIRS method in the case of inguinal hernia does not result in testicular atrophy or a decrease of the volume of the testis on the operated side. StreszczenieWprowadzenie: Operacja laparoskopowa przepukliny pachwinowej u dzieci sposobem PIRS jest uznaną metodą leczenia stosowaną od kilkunastu lat. Cel pracy: Wpływ leczenia operacyjnego przepukliny pachwinowej metodą PIRS na zmianę objętości jądra. Materiał i metody:Pomiędzy styczniem 2016 a grudniem 2019 roku przeprowadzono badanie prospektywne w Uniwersyteckiej Klinice Chirurgii Dziecięcej. Do badania włączono 29 chłopców w wieku 0-8 lat. Analizie poddano zmianę objętości jądra w ultrasonografii przed zabiegiem chirurgicznym i po zabiegu. Badano zmianę objętości jądra strony operowanej w stosunku do jądra, które nie było poddane zabiegowi. Porównano zmianę objętości jądra operowanego przed zabiegiem i po zabiegu oraz jądra strony przeciwnej, które nie było poddane procedurze PIRS. Wyniki i wnioski: Ultrasonograficzne pomiary objętości jąder po zabiegu chirurgicznym nie wykazały zahamowania wzrostu w przedoperacyjnym badaniu ultrasonograficznym jądra strony przeciwnej, nieoperowanej. Zaobserwowano wzrost mediany objętości obu jąder w przypadkach przed planowanymi operacjami chirurgicznymi i po nich, chociaż nie stwierdzono różnicy istotnej statystycznie. Operacja nagła z powodu uwięźniętej przepukliny po obu stronach nie wpłynęła statystycznie istotnie na objętość jąder w badanej grupie pacjentów. U żadnego z operowanych laparoskopowo pacjentów nie wystąpił zanik jąder. Operacja laparoskopowa metodą PIRS w przypadku przepukliny pachwinowej nie powoduje zaniku jąder ani zmniejszenia objętości jądra po stronie operowanej.

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“…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].…”

Section: Study Selectionmentioning

confidence: 99%

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

Eurlings,

Killaars,

Visschers

et al. 2024

Children

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Background: The effect of pediatric inguinal hernia repair (IHR) on testicular vascularization remains unclear. Manipulating the spermatic cord during surgery may reduce blood flow due to edema and vasoconstriction. This can lead to testicular atrophy. The study aims to review current knowledge of testicular vascular impairment following IHR in children. Methods: A systematic literature search was conducted in PubMed/Medline, Embase, Cochrane Library, and Web of Science. Methodological quality was assessed using validated tools. Data were extracted, and a pooled data analysis was performed. Results: Ten studies were included in the systematic review. Six of these studies were eligible for meta-analysis. This revealed a significant decrease in testicular vascularization during the short-term follow-up (1 day–1 week) after IHR using the open surgical approach. This decrease was not present after laparoscopic intervention. There was no more increased resistance in the vessels at long-term follow-up (1 month–6 months), suggesting that the impaired vascularity is only temporary. Conclusions: There seems to be a short-term transient vascular impairment of the testis after open IHR in children. This might be of clinical relevance to prefer the laparoscopic approach for IHR in children, even though the open approach is the gold standard, in contrast to adult IHR. The impact on testicular function and sperm quality later in life remains unclear. Comparative studies of both techniques are needed to determine if there is a significant difference in testicular vascularity. Long-term studies are necessary to assess the impact of transiently reduced vascularity on sperm quality and fertility later in life.

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Laparoscopic repair of pediatric inguinal hernia—is vascularity of the testis at risk? A study of 125 testes

Cited by 13 publications

References 20 publications

A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study

A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study

Analysis of volume change of the testis after inguinal hernia repair using the PIRS method – a prospective pilot study

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

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