Effects of totally extraperitoneal (TEP) and Lichtenstein hernia repair on testicular blood flow and volume.
BACKGROUND
Laparoscopic totally extraperitoneal hernia repair (TEP) has been compared with the open technique in several studies in terms of technical properties and perioperative outcomes. There are few studies that compare the long-term effects of each technique on testicular structure and function on the side of the hernia repair. The objective of this study is to investigate the effects at 6 months of the TEP and the Lichtenstein technique on testicular volume and arterial flow by the use of Doppler ultrasonography.


METHODS
A total of 148 men with a unilateral hernia were randomized prospectively to undergo TEP or Lichtenstein repair. In both groups, unilateral resistive indices, pulsatile indices of capsular and intratesticular artery flow, and testicular volume (in milliliters) were measured preoperatively and 6 months postoperatively by the use of grayscale and color Doppler ultrasonography (CDUS). The primary outcomes of the study were postoperative findings from history, physical examination, and CDUS measurements at 6 months postoperatively. Demographics, clinical and operative data, CDUS measurements, and recurrence patterns were analyzed.


RESULTS
Of 148 procedures, 134 cases consisting of 64 TEP and 70 Lichtenstein repairs were evaluated. Pre- and postoperative CDUS findings, rates of complications, and recurrence in both groups did not show any difference. Operative time was greater with a Lichtenstein repair (36 vs 30 minutes; P = .01).


CONCLUSIONS
Complications and recurrence rates and effects on testicular perfusion and testicular volume in both laparoscopic and open techniques are similar, whereas the laparoscopic approach has shorter operative time than open hernia repair.
Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey. Electronic address: ekabul@gmail.com.
Esin Kabul
EK
Gürbulak
Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
Bünyamin
B
Gürbulak
Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
İsmail Ethem
İE
Akgün
Department of Radiology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Alper
A
Özel
Department of Radiology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Deniz
D
Akan
Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Sinan
S
Ömeroğlu
Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Ayhan
A
Öz
Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Mehmet
M
Mihmanlı
Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
Hasan
H
Bektaş
D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D013737:Testis / Q000098:blood supply* / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult