Laparoscopic inguinal hernia repair does not impair testicular perfusion
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Felix Schier1, Salmai Turial, Thomas Hückstädt
1Department of Pediatric Surgery, University Medical <schier@kinderchir.klinik.uni-mainz.de>
Insights
Laparoscopic inguinal hernia repair does not harm testicular blood flow in boys. This study found no negative impact on testicular perfusion after the procedure, even during long-term follow-up.
Area of Science:
- Pediatric Surgery
- Urology
- Medical Devices
Background:
- Suture closure of the internal ring during laparoscopic inguinal hernia repair raises concerns about testicular vessel compromise.
- Evaluating the impact of this surgical technique on testicular perfusion is crucial for patient safety.
Purpose of the Study:
- To assess pre- and postoperative testicular perfusion in boys undergoing laparoscopic inguinal hernia repair.
- To compare testicular perfusion in these patients with healthy controls.
Main Methods:
- Sixty-five boys with inguinal hernias underwent laparoscopic repair.
- Testicular perfusion was measured using a neuromonitoring device (O2C) assessing oxygen saturation, hemoglobin volume, and blood flow/velocity at 8-mm depth.
- Measurements were taken before anesthesia, before/after surgery, and at 6-week follow-up, with 21 healthy boys as controls.
Main Results:
- Testicular oxygen saturation ranged from 62-75%, and relative blood flow was higher than in controls, solely influenced by inspired oxygen.
- Relative hemoglobin volume and blood flow velocity remained unchanged post-surgery.
- Perfusion values were normal at early and long-term follow-up.
Conclusions:
- Laparoscopic inguinal hernia repair with suture closure of the internal ring does not impair testicular perfusion in pediatric patients.
- The findings support the safety of this surgical approach regarding testicular vascular integrity.
Background:
Laparoscopic inguinal hernia repair techniques close the internal ring with a suture. Concern has been raised whether or not the testicular vessels are compromised with this technique. This study was undertaken to evaluate pre- and postoperative testicular perfusion and to compare it with healthy controls.
Patients And Method:
Sixty-five boys (aged 6 weeks to 11 years; median, 1.4 years) with unilateral (n = 52) or bilateral (n = 13) inguinal hernias were treated laparoscopically. Testicular perfusion was measured using a recently developed neuromonitoring device (O2C; LEA Medizintechnik GmbH, Giessen, Germany), which combines light spectroscopy and laser Doppler technique. An optical probe was placed on the surface of each scrotal pouch for measurements at 2 depths (2 and 8 mm). Measurements involved oxygen (O(2)) saturation at the venous end of capillaries, the amount of hemoglobin within microvessels, the blood flow within microcirculation, and the velocity of the blood in microcirculation. Measurements were conducted before and after anesthesia, before and after surgery, and 6 weeks later. Twenty-one healthy boys of similar ages served as controls.
Results:
Measurements at 2-mm depth were unreliable. At 8-mm depth, the oxygen saturation of hemoglobin was between 62% and 75% (hypoxia would be <10%). The relative blood flow was between 160 to 235 arbitrary units, better than in healthy awake controls. Values were solely influenced by the administered fraction of inspired oxygen. Relative hemoglobin volume of the testes and blood flow velocity remained unchanged after surgery. Values were also normal when measured during early and long-term follow-up.
Conclusion:
Laparoscopic inguinal hernia repair using suture closure of the internal inguinal ring does not impair testicular perfusion.