A testis may rarely atrophy following hernia surgery. This occurs when there is thrombosis of the testicular veins, resulting in intense venous congestion followed by ischemic orchitis. Relatively minor trauma to the venous plexus is sufficient to initiate the process, and avoidance of certain precipitating conditions can greatly reduce the occurrence of this complication.
Features:
(1) previously palpable testis now absent or greatly reduced in size
(2) exclusion of retractile testis
(3) history of recent hernia surgery
(4) as the ischemic orchitis develops, the testis may be swollen, painful and tender. With atrophy the testis is painless and nontender.
(5) suppuration is not typical and suggests another process
Increased Risk for Syndrome
Low Risk for Syndrome
anterior hernia repair (involves dissection of the spermatic cord and sensory nerves)
posterior hernia repair, OR using a preperitoneal approach (avoids dissection along the cord)
extensive dissection along the spermatic cord
very limited dissection along the spermatic cord
large indirect hernia sac, especially if recurrent
direct hernia sac or small indirect hernia
extensive dissection of the distal aspect of a large indirect hernia sac
never dissecting the cord below the pubic tubercle
If a person has bilateral hernias, it is prudent to repair the 2 sides separately, waiting 1 year after the first operation to make sure that testicular atrophy does not occur.
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