Lal P, Bansal B, Sharma R, Pradhan G
Department of General Surgery, Maulana Azad Medical College, New Delhi, India.
, C-35, New Agra Colony, Agra, U.P., 282005, India.
Hernia. 2016 Jun;20(3):429-34. doi: 10.1007/s10029-016-1479-5. Epub 2016 Feb 29.
The effect of laparoscopic TEP repair on testicular perfusion is unclear. The procedure entails dissection of testicular blood vessels off the hernial sac and incorporation of a prosthetic mesh. This carries at minimum, a theoretical risk of compromise in testicular blood supply, which in turn may affect fertility. Our study aims to establish if any alteration in testicular perfusion occurs in very early (24 h), early (1 week) or late postoperative period (3 months) after laparoscopic TEP repair in the Indian population.
In our prospective trial, 20 patients underwent unilateral and 8 underwent bilateral laparoscopic TEP hernia repairs using standard technique by experienced surgeons. Flow parameters of testicular, capsular and intratesticular artery were noted using color Doppler ultrasound preoperatively and postoperatively and the postoperative resistive indexes of operated side (n = 36) were compared with preoperative values. Additionally, for unilateral repairs, flow parameters on operated side were compared with the non-operated side.
No statistically significant difference was noticed in the resistive index of the arteries upon comparing these postoperative with preoperative values. For unilateral repairs, the flow parameters of the operated side were comparable with that of non-operated side (i.e. p > 0.05).
Laparoscopic TEP performed by experienced surgeons does not alter testicular flow dynamics in early or late postoperative period.
腹腔镜经腹膜前修补术（TEP）对睾丸灌注的影响尚不清楚。该手术需要将睾丸血管从疝囊上分离，并植入人工补片。这至少在理论上存在损害睾丸血液供应的风险，进而可能影响生育能力。我们的研究旨在确定在印度人群中，腹腔镜TEP修补术后极早期（24小时）、早期（1周）或晚期（3个月）睾丸灌注是否会发生任何改变。
在我们的前瞻性试验中，20例患者接受了单侧腹腔镜TEP疝修补术，8例患者接受了双侧腹腔镜TEP疝修补术，均由经验丰富的外科医生采用标准技术进行。术前和术后使用彩色多普勒超声记录睾丸、包膜和睾丸内动脉的血流参数，并将手术侧（n = 36）的术后阻力指数与术前值进行比较。此外，对于单侧修补术，将手术侧的血流参数与未手术侧进行比较。
将术后与术前的动脉阻力指数进行比较时，未发现统计学上的显著差异。对于单侧修补术，手术侧的血流参数与未手术侧相当（即p > 0.05）。
由经验丰富的外科医生进行的腹腔镜TEP在术后早期或晚期不会改变睾丸血流动力学。
