How are ischemic orchitis and thrombosis managed following open inguinal hernia repair?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Ischemic orchitis leading to testicular atrophy is a rare but well-known complication of inguinal hernia surgery. The patient may complain of pain and testicular swelling postoperatively. Symptoms may last for 2-3 months, and testicular atrophy may occur. The rarity of this complication notwithstanding, the surgeon should maintain a high index of suspicion. Testicular ultrasonography and Doppler studies may facilitate early diagnosis and help avoid orchiectomy. Ischemic orchitis is thought to be secondary to venous thrombosis rather than arterial injury.

Thrombosis is caused by surgical trauma to the delicate veins of the pampiniform plexus and disruption of the collateral blood supply to the testes during an attempt at complete removal of a large hernia sac. It is also more likely in operations for recurrent hernia. It is thus advisable not to attempt complete dissection and excision of a large hernia sac. The neck of the hernia sac is transected at the midpoint of the inguinal canal, and the distal sac is left in place. However, the anterior wall of the distal sac is incised to prevent postoperative hydrocele.

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