Electrophysiologic evaluation of genitofemoral nerve in children with inguinal hernia repair

A single-blinded, randomized comparison of laparoscopic versus open bilateral hernia repair in boys

AIM

The aim of this study is to determine whether laparoscopic repair (LR) of inguinal hernia is superior to open repair (OR) in bilateral cases.

SUBJECTS AND METHODS

Sixty-two boys older than 6 years with bilateral hernias were included in our prospective, randomized, single-blinded clinical trial. All patients were administered morphine via patient-controlled analgesia for 24 hours. Pain scores were evaluated by the patients using a visual analog scale (VAS) at 1, 2, 4, 12, and 24 hours postoperatively. Operative time, pain scores, analgesic doses, and first mobilization attempt were evaluated. Parents also provided assessments of their children's recovery and wound appearance.

RESULTS

Operative time was found to be slightly higher in OR compared with LR. VAS scores were higher in OR than in LR at 1 hour postoperatively (6.78 versus 3.88, respectively; P<.05). At the other times, VAS scores showed no significant differences. Although OR patients requested and delivered analgesics more frequently than LR patients, the difference was not significant. The scores given by parents for wound appearance were significantly higher in the bilateral LR group than in the bilateral OR group (89±4.23 and 78±6.7, respectively; P<.05).

CONCLUSIONS

This trial demonstrates that LR in bilateral cases offers benefits compared with OR in terms of lower pain scores and analgesic requirements and of reduced operative and patient recovery times. However, the only significant difference was better wound cosmesis in bilateral LR cases.

An electrophysiologic evaluation of whether open and laparoscopic techniques used in pediatric inguinal hernia repairs affect the genitofemoral nerve

BACKGROUND

A prospective study was performed to evaluate the effect of inguinal hernia repairs on the genitofemoral nerve (GFN), and to compare postoperative electrophysiologic changes in the GFN of patients who had undergone either open or laparoscopic surgery.

METHODS

Seventy patients with a mean age of 6.48 ± 3.49 were enrolled in the study. Either open or laparoscopic techniques were used to operate on the patients' inguinal hernias. In all cases, bilateral GFN motor responses were investigated electrophysiologically using surface electrodes on three occasions: preoperatively, in the first month, and third month postoperatively. t-Tests were used to compare changes in the GFN.

RESULTS

Preoperative mean latency of the GFN in all groups was found to be significantly prolonged on the hernia side, compared with the non-hernia side (P = 0.01). Although no difference was observed in the latency levels of the GFN on the operated side at the preoperative and early postoperative stages, GFN latency levels decreased significantly in the late postoperative period in the laparoscopic group (P < 0.05). In the late postoperative period, amplitudes of GFN motor responses were significantly higher in the laparoscopic group than the open repair group (0.91 ± 0.11 mV and 0.57 ± 0.053 mV, respectively; P < 0.05).

CONCLUSION

Preoperative prolonged latency of GFN on the hernia side is likely to occur due to the pressure on the nerve caused by the hernia mass. By surgically removing the hernia mass, this buildup of pressure is prevented, decreasing the latency of the GFN. The significantly higher motor response amplitudes and decreased latency in the late postoperative stage for the laparoscopic group may be due to the fact that this technique is less invasive.

Infertility in rats subjected to genitofemoral nerve section is not associated with testicular damage

This work was aimed at assessing the relationship between testicular ascent and infertility induced by genitofemoral nerve (GFN) section in rats. Eighteen male rats were assigned to three experimental groups as follows: (i) Group SGFN was subjected to surgical section of genitofemoral nerve; (ii) Group Sham; (iii) Control group. The GFN was cut at puberty (28D), and the contralateral testis removed at 90D, with fertility tests at 120D. At 150D, maturity index, epithelial area and histopathological index of seminiferous tubules of all rats were determined and statistically compared between superior and inferior testicle poles, and between groups. There were no differences in testicular parameters, sperm morphology or sperm concentrations (P > 0.05). Section of NGF interfered with fertility (58.3 ± 15.4 in SGFN versus 83.3 ± 10.5 in Sham) and litter size (6.2 ± 1.1 in SGFN versus 10.7 ± 1.4 in Sham). Cremaster of SGFN group showed early neuropathy. The GFN section induced partial testicular ascent and diminished fertility without damage on testicular morphology or spermatic parameters, because, cremaster could affect the contractibility and ejaculation mechanisms in which it participates. The study of the damage on cremaster induced by an injury on GFN could have an overview of the mechanisms inherent in the testicular ascent induced by this iatrogenic alteration and their potential risks on fertility.