Study of alteration in testicular perfusion after Lichtenstein hernia repair

Authors

  • Hans Raj Ranga Department of General Surgery, PGIMS Rohtak, Haryana, India
  • Vinit Mishra Department of General Surgery, PGIMS Rohtak, Haryana, India
  • Vidit Vidit Department of General Surgery, PGIMS Rohtak, Haryana, India
  • Mahavir Griwan Department of General Surgery, PGIMS Rohtak, Haryana, India
  • Bhavinder K. Arora Department of General Surgery, PGIMS Rohtak, Haryana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20240172

Keywords:

Capsular artery, Color Doppler, End diastolic volume, Inguinal hernia, Intratesticular artery, Lichtenstein repair, PSV, Resistance index, Testicular artery, Testicular perfusion

Abstract

Background: Inguinal hernia affects both men and women but is much more common in men who comprise over 90% of the operated patients. Considering both the operated and the non-operated inguinal hernias, the lifetime prevalence rate is 47% for men upto and including the age of 75. Repair of an inguinal hernia is one of the most common operations among adults in the western world today. Aims and objectives were to compare the alteration in testicular perfusion following Lichtenstein hernia repair.

Methods: Thirty patients diagnosed with inguinal hernia admitted in our hospital with study period of 12 months were included in the study. Color Doppler ultrasound evaluation of testicular blood flow was done for all cases. Comparisons of results between groups were done using independent t test and Pearson correlation test.

Results: The mean age of patients in the study was 46.10±17.27 years. Twenty three percent of patients had COPD as comorbidity. Mean peak systolic volume (PSV) of testicular artery in preop, at 24 hours, 1 week and 3 months are 18.36±2.21, 20.27±3.25, 19.21±2.31 and 18.98±2.06 respectively with a p=0.001. On further observations, no significant difference was found in the PSV of Capsular and intratesticular artery and EDV and RI of testicular, capsular and intratesticular artery.

Conclusions: Testicular perfusion following hernioplasty can be easily monitored and evaluated with Duplex ultrasonography; the flow in the spermatic artery and testicular artery and its branches is of low resistance, with a relatively broad systolic part and holodiastolic flow. There is no evidence for a significant impairment of cord structures after open hernia repair using tension free techniques. It is clear that fine surgical dissection

References

Abramson I, Gofin J, Hopp C, Makler A, Epstein LM. The epidemiology of inguinal hernia. A survey in western Jerusalem. J Epidemiol Commu Hlth. 1978;32(1):59-67.

Primatesta P, Goldaere MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 1996;25(4):835-9.

Fitzgibbons RJ, Giobbie HA, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M et al. Watchful waiting vs. repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006;295(3):285-92.

Amid PK. Lichtenstein open tension-free hernioplasty. Woodbury, CT: Cine-Med. 1997;100:187-90.

Usher FC, Hill JR, Ochsner JL. Hernia repair with Marlex mesh: a comparison of techniques. Surgery 1959;46:718-24.

Fong MD, Wantz GE. Prevention of ischemic orchitis during inguinal hernioplasty. Surg Gynecol Obstet 1992;174(5):399-404.

Reid I, Devlin HB. Testicular atrophy as a consequence of inguinal hernia repair. Br J Surg. 1994;81(1):91-6.

Klinge U, Klosterhallen B. Muller M. Foreign body reaction to meshes used for the repair of abdominal wall hernias. Fur J Surg. 1999;165(7):665-9.

Middleton WD, Thorne D, Nielson GL. Colour Doppler ultrasound of the normal testis. AJR Am J Roentgenol. 1989;152(2):293-7.

Ger R. The laparoscopic management of gionin hernias. Contempt Surg. 1991;39(1):15-9.

Lima Neto EV, Goldenberg A, Jucá MJ. Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia. Acta Cirurgica Brasileira. 2007;22(4):266-71.

Sucullu I, Filiz AI, Sen B, Ozdemir Y, Yucel E, Sinan H et al. The effects of inguinal hernia repair on testicular function in young adults: a prospective randomized study. Hernia. 2010;14(2):165-9.

Hatipoğlu S, Turhan AN, Kapan S, Gönenç M, Palabıyık F, Aygün E. The comparison of the effects of the anterior preperitoneal mesh repair and Lichtenstein procedure on testicular blood flow and volume in patients with inguinal hernias. Med J Bakırköy. 2010;6:14-9.

Koksal N, Altinli E, Sumer A, Celik A, Onur E, Demir K et al. Impact of herniorraphy technique on testicular perfusion: results of a prospective study. Surg Laparosco Endosco Percut Tech. 2010;20(3):186-9.

Nath P, Dey S, Karim T, Jain A, Katiyar VK, Patel G. Study of testicular perfusion after Lichtenstein hernioplasty in uncomplicated inguinal hernia. Int Surg J. 2018;5:1104-10.

Skandalakis JE, Skandalakis LJ, Colborn GL. Testicular atrophy and neuropathy in herniorrhaphy. Am Surg. 1996;62(9):775-82.

Uzzo RG, Lemack GE, Morrissey KP, Goldstein M. Effects of mesh bioprosthesis on the spermatic cord strutures: a preliminary report in a canine model. J Urol. 1999;161(4):1344-49.

Zwiebel WJ, Pellerito JS. Conceitos básicos da análise do espectro de freqüência Doppler e exame ultra-sônico do fluxo sanguíneo. In: Zwiebel WJ, Pellerito JS. Introdução a ultra-sonografia vascular. 5th Ed. São Paulo: Elsivier. 2005:45-64.

Fernandez EJM, Mora ODP, Tamayo YG, Becomo AGL, Aladro F. Testicular perfusion in Lichtenstein hernioplasty. Revista Cubana de Cirugia. 2016;55(1):12-20.

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Published

2024-01-30

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Original Research Articles