Testicular damage after surgical groin exploration for elective herniorrhaphy

Background/Purpose: Controversy exists whether to explore the contralateral groin in boys during unilateral herniorrhaphy. Proponents claim there is m inimal risk of injury to the cord structures and developing testicle with c ontralateral exploration. However, findings have shown testicular atrophy o ccurred in 1% to 2% of patients after herniorrhaphy, and vasal damage is po ssible after routine manipulation of the spermatic cord. This study investi gated the effect of routine surgical exploration of the prepubertal groin o n testicular development and future fertility. Methods: Twenty-four prepubertal Wistar rats were divided equally into 2 gr oups. Group 1 (sham) rats underwent unilateral inguinoscrotal incision only . Group 2 (experimental) rats underwent unilateral inguinoscrotal explorati on with manipulation of the cord structures as in human inguinal exploratio n. At maturation, the fertility and fecundity of the males were assessed. A fter mating, testes were examined for mass, volume, mean seminiferous tubul e diameter (MSTD), and mean testicular biopsy score (MTBS). The vasa were e xamined for histological injury and vasal diameter. Statistical comparisons were made by paired t test and Mann-Whitney rank sum test. Results: There was a difference between the volumes of the testes when comp aring the operative and nonoperative side of the 2 groups (experimental, De lta vol = -0.063 +/- 0.123; sham, Delta vol = +0.067 +/- 0.137; P = .029). There also was a trend toward a smaller testicular mass when comparing the two sides (experimental, Delta mass = -0.045 +/- 0.101; sham, Delta mass = +0.048 +/- 0.123; P = .057) but did not reach significance. The MSTD and MT BS were similar between the ipsilateral and contralateral testes in both gr oups. Likewise, the MSTD and MTBS were similar when comparing the 2 groups. All male rats in both groups were fertile. The number of offspring produce d and the number of female rats impregnated were similar between the 2 grou ps. There was no histological evidence of vasal injury in any of the experi mental spermatic cords. The vasal diameters were similar between the 2 grou ps. Conclusion: Surgical manipulation of the prepubertal spermatic cord imparts a small, but statistically significant morphological change in testicular size without a deleterious effect on testicular development, fertility or f ecundity. J Pediatr Surg 35:327-330. Copyright (C) 2000 by W.B. Saunders Co mpany.