SURGICAL TREATMENT OF INGUINAL HERNIA COMBINED WITH CRYPTORCHIDISM

Abstract

Objective: To evaluate outcomes of single-stage surgery performed for inguinal hernia combined with cryptorchidism. Methods: Between 2005 and 2020, 22 patients aged 3 to 28 years underwent surgery for inguinal hernias combined with cryptorchidism. All surgeries were performed using instrumentation, affording surgical precision through enhanced visualisation and magnification. The combination of the hernia with cryptorchidism was noted in 12 (54.5%) and 8 (36.4%) patients on the right and left sides, respectively. In addition, bilateral localisation of hernia and cryptorchidism was observed in 2 (9.1%) patients. In addition to clinical investigation, ultrasonography (US), Doppler ultrasonography (DU) and, to a limited extent, computed tomography (CT) were used preoperatively and in the long-term postoperative period. Dynamical changes in the threedimensional testicular measurements, testicular volumes and the time-averaged maximum velocity (TAMAX, cm/s) in the testicular arteries were evaluated. Results: In the immediate postoperative period, seroma formation and suppuration of wounds were not noted. However, in 3 (13.6%) cases, transient swelling of the scrotum was observed. According to ultrasound data, 6 months after single-stage operations, there was a statistically significant increase in all parameters of the operated testicle compared to the initial values, including three-dimensional testicular measurements and volume (p<0.05) in all age groups. In addition, 6 months after the operation, the sizes of surgically brought down and healthy testicles in all age groups became equal, except for the thickness of the testis in children aged 3-5 years. At the same time, according to DU data, there was also a statistically significant increase in TAMAX in the testicular artery on the side of the lesion (p<0.001). Conclusion: The use of instrumentation, affording surgical precision through enhanced visualisation and magnification when performing surgery for inguinal hernia and cryptorchidism, is the gold standard treatment. Because it prevents iatrogenic damage to critical anatomical structures, allows maximum mobilisation of the vascular pedicle of the retained testicle and contributes to the safe bringing down of the latter without much tension. The selection of an appropriate hernial orifice reconstruction method, along with the recurrence prevention, also helps to avoid compression of the elements of the spermatic cord and thus improve the fertile function. Keywords: Inguinal hernia, cryptorchidism, a combination of inguinal hernia and cryptorchidism.