Ultrasonic criteria of comparison of laparoscopic and traditional surgical treatment of inguinal hernias in boys

Abstract

The aim of the work: to investigate the dynamics of indicator intratesticular blood flow and structure of the testis after laparoscopic and traditional surgical treatment of inguinal hernias in boys.

Materials and Methods. We analyzed the results of ultrasonography in preoperative and postoperative period in boys with inguinal hernias. There were surveyed 102 patients (aged 0 to 12 years) operated on traditional or laparoscopy techniques. All patients were divided into 2 groups according to operative method. Patients of the group 1 (N=34, average age of 1.5±0.15 years) underwent lapa­roscopic intervention according to the method of PIRS. In group 2 (N = 68, mean age of 4.5±0.32) we performed surgery according to the traditional Duhamel method. Criteria of comparison were the resistance index, peak systolic and diastolic velocity of intratesticular blood flow before surgery and in the postoperative period on 7, 14, 30 days and 6 mo nths follow-up.

Results and Discussion. In the postoperative period on the 7th day in the group of patients operated laparoscopically according to the ultrasound we noticed a slight thickening of the membranes of the testis in 2 patients (6.7 %), which clinically corresponds to a small swelling, but in the future when examining at 14th, 30th day and 6 months, these changes were absent. In the group of patients operated by conventional technique in 28 patients (41.17 %) we noticed a significant thickening walls of the scrotum, the presence of the liquid, which corresponded clinically significant edema. On the 7th, 14th, 30th day postoperative observation in the middle age group of children operated with traditional technique (subgroup B), we noted a significant increase in the volume of testis (0.71±0.02 cm3., 0.68±0.01 cm3, and 0.66±0.010 cm3), respectively, compared with the control group (or 0.60±0.010 cm3, p<0.05). It is found that the resistance index in the junior, intermediate and senior group undergoing laparoscopic surgery (subgroup A) was much lower than in the group operated according to the traditional method. In laparoscopically operated group I it was 0.723 ± 0.01 vs group B where it was 0.765 ± 0.03, p<0.05). And in the second group 0.714 ± 0.01 to 0.829 of ± 0.01 in II B, p<0.001. In the third group IR on the 7th day and 14th day were higher at the beginning of treatment. It is important to note, the worst performance was on the 7th day after surgery because of postoperative swelling. To entry level IR is not recovered in groups B even on the 30th, regardless of age. After a traditional surgical intervention indicators of Doppler ultrasound were associated with increased peak systolic velocity and IR, respectively, and a decrease of the end diastolic velocity.