Department of Pediatric Surgery of Hazrat Masoume Hospital, Qom University of Medical Sciences, Qom, Iran.
Student Research Committee, Qom University of Medical Sciences, Qom, Iran.
Ascending testis (AT) is one of the rare but serious complication that may occurs following inguinal hernia/hydrocele repair. We aimed to review our more than 7 years’ experience and discuss the possible mechanism through which the AT possibly occurs following inguinal hernia/hydrocele repair.
Materials and Methods
A retrospective analysis of 7,212 boys who had undergone inguinal hernia/hydrocele repair between March 2009 and April 2016 was conducted. Exclusion criteria were: undescended testis, misdiagnosed AT, and retractile testis. Two types of surgical procedures were performed based on the medical records: (1) transection of the hernia sac and processus vaginalisalone and (2) isolation of the vas deferens and testicular vessels and a global transection of the remaining structures. Subsequently, post-operative incidence of AT was compared across variables extracted from the medical records.
Sixteen (0.22%) patients were diagnosed with AT post operatively. AT incidence after inguinal hernia/hydrocele repair was reported in approximately 0.19% of the entire patient sample (in the 8491 hernia/hydrocele repairs). Comparison of AT incidence with the age at initial operation showed significant increase at the age of one year or less (P =0.017). In addition, AT incidence was significantly higher in the patients for whom only the sac/processus vaginalis was transected rather than the patients who underwent hernia/hydrocele repair with isolation of the vas deferens and testicular vessels (0.06% vs. 0.27%, respectively, P =0.023). Other subgroup analyses remained non-significant.
We conclude that transection of the cremaster muscle might decrease the incidence of ascending testis following inguinal hernia/ hydrocele repair.