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Do open repair and different laparoscopic techniques in pediatric inguinal hernia repairs affect the vascularization
Süleyman Çelebi1, Abdullah Yıldız, Ayhan Üçgül
1Department of Paediatric Surgery, Şişli Etfal Training and Research Hospital, 34381 Istanbul, Turkey.
Insights
Pediatric inguinal hernia repair using open or laparoscopic techniques does not impair testicular blood flow. Doppler ultrasound confirmed no significant changes in testicular perfusion after either surgical method.
Area of Science:
- Pediatric Surgery
- Vascular Imaging
- Hernia Repair
Background:
- Inguinal hernias are common in children.
- Surgical repair is standard, but concerns exist regarding potential testicular vascular compromise.
- Doppler ultrasonography is a non-invasive tool to assess blood flow.
Purpose of the Study:
- To evaluate the impact of different pediatric inguinal hernia repair techniques on testicular perfusion.
- To compare open versus laparoscopic methods using Doppler ultrasound.
Main Methods:
- Prospective clinical trial involving 72 pediatric patients with unilateral inguinal hernia.
- Three repair techniques were used: conventional open, Schier intracorporeal laparoscopic, and Montupet laparoscopic.
- Doppler ultrasound assessed testicular artery peak systolic velocity (PSV) and resistivity index (RI) preoperatively and postoperatively.
Main Results:
- The conventional open repair group showed transient, non-significant changes in PSV and RI.
- No significant changes in testicular perfusion parameters were observed in the two laparoscopic groups.
- Overall, neither surgical approach led to statistically significant impairment of testicular vascularization.
Conclusions:
- Both conventional open and laparoscopic hernia repair techniques are safe regarding testicular vascularization in pediatric patients.
- Transient, insignificant vascular changes may occur with open repair but do not pose a clinical concern.
- Laparoscopic techniques demonstrate no adverse effects on testicular blood flow.
Purpose:
The aim of this study was to evaluate, using Doppler ultrasonography, the effects of different hernia repair techniques on testicular perfusion in the pediatric age group.
Methods:
This study was based on a prospective clinical trial of 72 pediatric patients over 2 years of age with unilateral inguinal hernia. They were operated on using 1 of 3 different techniques. Group 1 included 26 patients who were treated with a conventional open hernia repair technique. Group 2 included 22 patients who underwent Schier intracorporeal laparoscopic suture technique. Group 3 included 24 patients who underwent the laparoscopic partial excision and purse-string technique described by Montupet. In all cases, blood flow index of the centripetal and capsular arteries of the testes, including peak systolic velocity (PSV) and resistivity index (RI), were examined by using Doppler ultrasound preoperatively and early and late postoperatively.
Result:
The conventional open technique group (group 1) had transient temporary changes in PSV and RI values compared with preoperative findings; however, these changes were not statistically significant. No such changes were observed in the 2 laparoscopic groups.
Conclusion:
Neither conventional open nor laparoscopic hernia repair techniques impaired testes vascularization. Surgical manipulations performed using the conventional open repair technique caused transient, but not significant, changes in PSV and RI values.
