Laparoscopic inguinal hernia repair does not impair testicular perfusion

Abstract 

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 (O₂) 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.