Eurlings Roxanne, Killaars Rianne E M, Visschers Ruben G J, van Gemert Wim G
Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences (FHM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
Department of Pediatric Surgery, MosaKids Children's Hospital, Maastricht University Medical Center+, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
Children (Basel). 2024 Mar 29;11(4):409. doi: 10.3390/children11040409.
The effect of pediatric inguinal hernia repair (IHR) on testicular vascularization remains unclear. Manipulating the spermatic cord during surgery may reduce blood flow due to edema and vasoconstriction. This can lead to testicular atrophy. The study aims to review current knowledge of testicular vascular impairment following IHR in children.
A systematic literature search was conducted in PubMed/Medline, Embase, Cochrane Library, and Web of Science. Methodological quality was assessed using validated tools. Data were extracted, and a pooled data analysis was performed.
Ten studies were included in the systematic review. Six of these studies were eligible for meta-analysis. This revealed a significant decrease in testicular vascularization during the short-term follow-up (1 day-1 week) after IHR using the open surgical approach. This decrease was not present after laparoscopic intervention. There was no more increased resistance in the vessels at long-term follow-up (1 month-6 months), suggesting that the impaired vascularity is only temporary.
There seems to be a short-term transient vascular impairment of the testis after open IHR in children. This might be of clinical relevance to prefer the laparoscopic approach for IHR in children, even though the open approach is the gold standard, in contrast to adult IHR. The impact on testicular function and sperm quality later in life remains unclear. Comparative studies of both techniques are needed to determine if there is a significant difference in testicular vascularity. Long-term studies are necessary to assess the impact of transiently reduced vascularity on sperm quality and fertility later in life.
小儿腹股沟疝修补术（IHR）对睾丸血管化的影响尚不清楚。手术过程中对精索的操作可能会因水肿和血管收缩而减少血流。这可能导致睾丸萎缩。本研究旨在综述目前关于小儿IHR术后睾丸血管损伤的知识。
在PubMed/Medline、Embase、Cochrane图书馆和Web of Science中进行了系统的文献检索。使用经过验证的工具评估方法学质量。提取数据并进行汇总数据分析。
系统评价纳入了10项研究。其中6项研究符合荟萃分析的条件。这表明采用开放手术方法进行IHR后，在短期随访（1天至1周）期间睾丸血管化显著降低。腹腔镜干预后未出现这种降低。在长期随访（1个月至6个月）时血管阻力没有进一步增加，表明血管损伤只是暂时的。
小儿开放IHR术后睾丸似乎存在短期短暂的血管损伤。这可能在临床上具有相关性，即对于小儿IHR，即使开放手术方法是金标准，但与成人IHR不同，更倾向于采用腹腔镜方法。对后期睾丸功能和精子质量的影响仍不清楚。需要对这两种技术进行比较研究，以确定睾丸血管化是否存在显著差异。有必要进行长期研究，以评估短暂性血管减少对后期精子质量和生育能力的影响。
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