Study of testicular perfusion after Lichtenstein hernioplasty in uncomplicated inguinal hernia

Prabhu Nath, Subhajeet Dey, Tanweer Karim, Atul Jain, Vivek Kumar Katiyar, Gaurav Patel


Background: Inguinal hernia repair is one of the most commonly performed surgical procedures in the world. The aim is to achieve a recurrence free hernia repair with minimum of complications. In mesh inguinal hernia repair testicular cord structures are in direct contact with the mesh. Testicular ischemia usually manifests within 48-72 hours after surgery. Aims of the study was to asses any changes in perfusion of ipsilateral testis after Lichtenstein hernioplasty and establish a baseline testicular perfusion pattern in the study population. This study was conducted in the Department of Surgery for one year at a tertiary care teaching hospital in Delhi.

Methods: All consenting adult male patients undergoing Lichtenstein inguinal hernioplasty for unilateral inguinal hernia fulfilling the inclusion and exclusion criteria. A sample size of 50 was included in study.

Results: In this study patients were above 18 and below 60 years of age with mean age of 43.58 years.  The paired T-test analysis revealed no statistically significant difference between pre and post-operative values of SV, DV, RI, PI and TV.

Conclusions: Lichtenstein tension free mesh repair for uncomplicated inguinal hernia does not impair testicular perfusion after the procedure.


Lichtenstein hernioplasty, Testicular perfusion, Testicular ischemia

Full Text:



Schumpelick V, Zimmer M. Atlas of hernia surgery. Decker, New York; 1990.

Fruchard H. Anatomic Chirurgicale des Hernies de Aine. G. Doin, Paris; 1956.

Dilek ON. Hernioplasty and testicular perfusion. Springerplus. 2014;3:107.

Fitzgibbons RJ. The mesh and the spermatic cord. In: Schumpelick V, Fitzgibbons RJ, edrs. Recurrent Hernia. Heidelberg, Springer; 2007;333-7.

Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, De Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients.

Coob WS, Kercher KW, Heniford T. The argument for lightweight polypropylene mesh in hernia repair. Surg Innov. 2005;12(1):20-7.

Lichtenstein IL, Shulman AG, Amid PK, Montflor MM. The tension-free hernioplasty. Am J Surg. 1989;157:188-93.

Turgut AT, Ölçücüoğlu E, Turan C, Kilicoglu B, Koşar P, Geyik PO, et al. Preoperative ultrasonographic evaluation of testicular volume and blood flow in patients with inguinal hernias. J Ultrasound Med. 2007;26(12):1657-66.

Lee SL, DuBois JJ, Rishi M. Testicular damage after surgical groin exploration for elective herniorrhaphy. J Pediatr Surg. 2000;35(2):327-30.

Lima Neto EV, Goldenberg A, Jucá MJ. Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia. Acta cirurgica brasileira. 2007;22(4):266-71.

Oyen RH. Scrotal ultrasound. In: Baert AL (eds) Syllabus ultrasound. Springer, Berlin; 2002:280-295.

Sucullu I, Filiz AI, Sen B, Ozdemir Y, Yucel E, Sinan H, et al. The effects of inguinal hernia repair on testicular function in young adults: a prospective randomized study. Hernia. 2010;14(2):165-9.

Hatipoğlu S, Turhan AN, Kapan S, Gönenç M, Palabıyık F, Aygün E. The comparison of the effects of the anterior preperitoneal mesh repair and Lichtenstein procedure on testicular blood flow and volume in patients with inguinal hernias. Med J Bakırköy. 2010;6:14-9.

Koksal N, Altinli E, Sumer A, Celik A, Onur E, Demir K, et al. Impact of herniorraphy technique on testicular perfusion: results of a prospective study. Surg Laparosco Endosco Percut Tech. 2010;20(3):186-9.

Dilek ON. Are there adverse effects of herniorrhaphy techniques on testicular perfusion?. In Hernia repair sequelae. Springer, Berlin, Heidelberg. 2010;3-11.

Skandalakis JE, Skandalakis LJ, Colborn GL. Testicular atrophy and neuropathy in herniorrhaphy. Am Surg. 1996;62:775-82.

Uzzo RG, Lemack GE, Morrissey KP, Goldstein M. Effects of mesh bioprosthesis on the spermatic cord strutures: a preliminary report in a canine model. J Urol. 1999;161:1344-49.

Zwiebel WJ, Pellerito JS. Conceitos básicos da análise do espectro de freqüência Doppler e exame ultra-sônico do fluxo sanguíneo. In: Zwiebel WJ, Pellerito JS. Introdução a ultra-sonografia vascular. 5th Ed. São Paulo: Elsivier; 2005:45-64.

Fernandez EJM, Mora ODP, Tamayo YG, Becomo AGL, Aladro F. Testicular perfusion in Lichtenstein hernioplasty. Revista Cubana de Cirugia. 2016;55(1):12-20.

Akbulut G, Serteser M, Yucel A, Degirmenci B, Yilmaz S, Polat C, et al. Can laparoscopic hernia repair alter function and volume of testis? Randomized clinical trial. Surg Laparosc Endosc Percutaneous Tech. 2003;13(6):377-81.

Middleton WD, Thorne DA, Melson GL. Color Doppler ultrasound of the normal testis. Am J Roentgenol. 1989 Feb 1;152(2):293-7.