Inguinal Approaches Research Articles

Beyond the Incision: A Comparative Study of Suprainguinal and Inguinal Varicocele Surgeries.

Background Varicocele, characterised by the abnormal dilation of the pampiniform plexus of scrotal veins, is a prevalent and treatable cause contributing to male infertility, affecting 40% of men experiencing primary infertility and 80% of those with secondary infertility. Often asymptomatic, it can lead to chronic scrotal pain or a feeling of heaviness. Surgical interventions such as open, laparoscopic, or microsurgical varicocelectomy aim to eliminate venous reflux into the scrotum. This study sought to assess and evaluate the surgical outcomes and postoperative complications of the suprainguinal and inguinal approaches to varicocelectomy, offering evidence-based insights to improve varicocele management. Methodology A total of 60 males diagnosed with grade II or III unilateral or bilateral varicocele were included in the study. Patients with subclinical or grade I varicocele, recurrent varicocele, or concomitant inguinoscrotal pathology (hydrocele, epididymal cyst, and inguinal hernia) were excluded. Participants were randomly assigned to one of two groups based on the surgical technique: Group A (suprainguinal approach) and Group B (inguinal approach). Surgical outcomes were assessed by evaluating operating time, postoperative pain, wound hematoma, wound infection, hydrocele development, testicular atrophy, and semen analysis, both pre- and postoperatively. Results The study included 60 patients with a mean age of 29.05±5.96 years and an age range of 18-40 years. The suprainguinal approach offers a significantly shorter operating time than the inguinal approach (33.1 vs. 40.8 minutes). Both surgical techniques resulted in similar postoperative pain levels. The incidence of complications, such as wound hematoma, wound infection, and hydrocele development, showed no significant differences between the two approaches. In Group A (suprainguinal approach), the rates were 3.3%, 6.6%, and 3.3%, respectively, while in Group B (inguinal approach), they were 6.6%, 13.3%, and 6.6%. Additionally, 75% of patients in the infertility group showed improvements in semen parameters, with 80% in Group A and 71.4% in Group B, with no significant difference between the surgical approaches. Conclusion The suprainguinal and inguinal approaches to varicocelectomy effectively manage varicoceles, with the suprainguinal approach offering a shorter operating time. Postoperative complications and improvements in semen parameters were comparable between the two methods.

Effects of Varicocele Repair on Sperm DNA Fragmentation and Seminal Malondialdehyde Levels in Infertile Men with Clinical Varicocele: A Systematic Review and Meta-Analysis.

Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA). A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD). Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I²=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I²=93.7%). Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.

Female sex and ipsilateral reoperation risk following mesh-based inguinal hernia repair: a cohort study including 131,626 repairs in adults from an integrated healthcare system over a 10-year period.

We sought to compare females and males for the risk of reoperation following different inguinal hernia repair approaches (open, laparoscopic, and robotic). We conducted a retrospective cohort study including all patients aged ≥ 18 who underwent first inguinal hernia repair with mesh within a US integrated healthcare system (2010-2020). Data were obtained from the system's integrated electronic health record. Multiple Cox proportional-hazards regression was used to evaluate the association between sex and risk for ipsilateral reoperation during follow-up. Analysis was stratified by surgical approach (open, laparoscopic, and robotic). The study cohort was comprised of 110,805 patients who underwent 131,626 inguinal hernia repairs with mesh, 10,079 (7.7%) repairs were in females. After adjustment for confounders, females had a higher risk of reoperation than males following open groin hernia repair (hazard ratio [HR] = 1.98, 95% CI 1.74-2.25), but a lower reoperation risk following laparoscopic repair (HR = 0.70, 95% CI 0.51-0.97). The crude 5-year cumulative reoperation probability following robotic repair was 2.8% in males and no reoperations were observed for females. Of females who had a reoperation, 10.3% (39/378) were for a femoral hernia, while only 0.6% (18/3110) were for femoral hernias in males. In a large multi-center cohort of mesh-based inguinal hernia repair patients, we found a higher risk for reoperation in females after an open repair approach compared to males. Lower risk was observed for females through a minimally invasive approach (laparoscopic or robotic) and may be due to the ability to identify an occult femoral hernia through these approaches.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

Сравнительная оценка эффективности использования пахового и мошоночного доступов при лечении рецидива крипторхизма.

Introduction. The average recurrence rate after inguinal orchiopexy is 1%, and with scrotal access – 3%. The high incidence of cryptorchidism determines a relatively large number of patients who need redo orchiopexy, which explains the interest in studying the results of the use of inguinal and scrotal approaches in the surgical treatment of recurrent cryptorchidism. Materials and methods. In the period from 2016 to 2021, 36 operations were performed for relapses of cryptorchidism. Right-sided cryptorchidism was in 22 (61.1%) patients, left-sided – 14 (38.9%) boys. The average age of patients was 6.4 ± 3.6 years (1.5-17.1 years). The study included patients whose entire testicular volume was located outside the scrotum. The patients were divided into two groups: group I, 21 (58.3%) children who had relapse eliminated by scrotal access, group II, 15 (41.7%) who used inguinal access. The duration of the operation and the time spent in the hospital, the frequency of repeated malposition and testicular atrophy, the duration of the use of analgesics were studied. Results. In group I patients, the median time of the operation was 35 minutes [25;100], the average length of hospital stay was 2.5 days, and the average duration of anesthesia was 0.4 days. In group II, the median time of the operation was is 90 minutes [60;130], which is significantly longer than in group I (p=0.002), the average length of stay in the hospital is 4 days, the average time of anesthesia is 1.4 days. In 2 (12.5%) patients of group I, there was a need for conversion and the use of inguinal access. 7 (19.4%) patients did not come for a follow-up examination. Group I included 16 (55.2%), group II 13 (44.8%) boys. Testicular atrophy was in group I in 1 (6.25%) patient, there was no malposition, in group II 2 (15.3%) there was atrophy, malposition in 1 (7.6%) case. Conclusion. Both scrotal and inguinal access during repeated orchiopexy are highly effective in the treatment of recurrent cryptorchidism, while scrotal access reduces the time of surgery and the extent of injury

Dynamics of the testicle volume after scrotal and trans-inguinal orchiopexy in children aged 6–18 months

BACKGROUND: Currently, scrotal and inguinal approaches are widely used for the treatment of low-positioned palpable forms of cryptorchidism. In the literature, available data demonstrate the comparability of the results obtained after using both techniques; however, the effectiveness reported in the literature was obtained based on rough criteria, such as the presence or absence of atrophy and malposition of the testis in the postoperative period.&#x0D; AIM: To study the dynamics of the testicular volume in the postoperative period after performing scrotal and trans-inguinal orchiopexy.&#x0D; MATERIALS AND METHODS: The study was based on the experience of treating 139 patients with palpable unilateral, low-positioned testis, aged up to 18 months, who underwent surgery within the period from 2010 to 2020. The low-positioned ones were those testicles that, during traction, could be descended beyond the superficial inguinal ring; however, the testis did not descend into the scrotum. By mechanical sampling, the patients were divided into two groups. Group I included 69 (49.6%) boys (median age, 17 [1517] months) who used scrotal access, whereas group II included 70 (50.4%) patients (median age, 15 [1417] months) with trans-inguinal access. The volume of the undescended testis was determined in both groups before surgery and after 1, 3, and 12 months.&#x0D; RESULTS: Patients who had testicular atrophy and malposition that developed after surgery, wound infection, and hematoma, and did not show up for at least one of the scheduled examinations were excluded from the study. After applying the exclusion criteria, 22 boys remained in group I and 29 boys in group II. The volume of a normal testicle before surgery was 2.09 cm3 [1.25; 2.58] group I and 1.69 cm3 [1.41; 2.22] in group II (p = 0.537). In group I, a significant increase was found in the testicular volume from 0.5 cm3 [0.4; 0.8] before surgery to 1.3 cm3 [0.7; 1.8] (p 0.001) a year after orchiopexy. In group II, the testicular volume increased from 0.6 cm3 [0.3; 0.8] before surgery to 0.7 cm3 [0.4; 1.0] after surgery.&#x0D; CONCLUSIONS:Scrotal access in the treatment of a palpable, low-positioned undescended testis in children aged 618 months provides a greater increase in the volume of the operated testicle in a year compared with trans-inguinal access 1 year after surgery. The results suggest that transcrotal access has some advantages over trans-inguinal access.

Systematic Review and Meta-Analysis of Inguinal Versus Classic Obturator Nerve Block.

Obturator nerve block (ONB) has been widely applied in transurethral resection of bladder tumor and knee surgery to prevent serious complications such as bladder perforation or to improve the quality of anesthesia during knee surgery. The classic/pubic and inguinal ONB methods are the two primary approaches used. The classic and inguinal ONB methods are two techniques for anesthetizing the obturator nerve, and each method may result in different respective outcomes. We aimed to compare the efficacy of the classic and inguinal methods. We presumed the inguinal approach to be an overall superior technique because it was recently invented and has been reported to provide numerous benefits. This study included randomized controlled trials comparing classic and inguinal approaches to ONB. Two independent investigators extracted study-level data for a random-effects meta-analysis of the comparison between the classic approach and inguinal approaches. We identified five studies comprising 312 patients. The pooled results revealed a higher success rate (risk ratio, 1.15; 95% confidence interval [CI], 1.04-1.27), fewer puncture attempts (mean difference, -0.84; 95% CI, -1.55 to -0.12), and shorter procedure time (mean difference, -28.87; 95% CI, -47.19 to -10.54) for patients given inguinal ONB. The inguinal approach is, overall, the superior method for performing the ONB procedure. The inguinal method resulted in a higher success rate, fewer puncture attempts, and shorter procedure time.

Üçüncü basamak bir çocuk cerrahisi merkezinde çocuklarda palpe edilemeyen testislerin laparoskopik tedavisinin klinik sonuçları

Aim: Non-palpable testis is defined as the absence of the testis in the inguinal canal and scrotum in a male patient. It is important to define the condition and location of the non-palpable testis, to prevent the risks of infertility and malignant transformation of the testis in patients. We aimed to evaluate the results of the laparoscopic approach we applied in the treatment of pediatric patients with non-palpable testes.Methods: Patients with non-palpable testes, diagnosed and treated by the laparoscopic approach in a tertiary pediatric surgery center, were evaluated retrospectively. In the treatment protocol, laparoscopic abdominal exploration, two-stage Fowler-Stephens laparoscopic orchiopexy, primary laparoscopic orchiopexy and inguinal exploration surgical approaches were applied according to the case characteristics.Results: Data from 54 testes in 45 pediatric patients were evaluated. Intra-abdominal testis was detected in 46.2% of the cases, with 88% of them at the entrance of the internal inguinal ring. After laparoscopic abdominal exploration, two-stage Fowler-Stephens in 7 (28%), primary laparoscopic orchiopexy in 18 (72%) were applied of testes. Inguinal exploration was performed in 27 (50%) whom no testis could not found. Seventeen (73.9%) of 23 testes that were descended into the scrotum remained viable, while atrophy occurred in 6 (26%) of them. Viable testis cells were not detected in the histopathology of 27 excised nubbins.Conclusion: The laparoscopic approach is a reliable and effective method in the diagnosis and treatment of non-palpable testis. Localization of intra-abdominal testes may support consideration of the inguinal exploration approach as the primary surgical intervention.

Comparison of the Inguinal and High Scrotal Approaches for the Treatment of Inguinal Hernias in Boys.

The conventional groin incision herniotomy is still being adhered to despite high success rate of high scrotal approach. Hence, the aim of this study was to compare the outcomes of high scrotal and conventional approaches for the treatment of inguinal hernia in boys. A prospective study of 100 boys with 108 inguinal hernias whose ages were less than 15 years. They were randomized into 2 groups; high scrotal and conventional approaches. Ninety-four patients with 101 hernias were analyzed. The operative time, conversion rate (high scrotal approach), and postoperative complications were reported. A total of 100 boys with 108 hernias were enrolled but 94 patients with 101 hernias were analyzed. They comprised of 48 patients with 51 hernias in the high scrotal group and 46 patients with 50 hernias in the conventional group. Their age range was between 2 months and 168 months with a mean of 47.9 ± 46.7 months. The conversion rate of high scrotal approach was 1.9%. The mean duration of operation in the high scrotal group was 37.1 ± 13.3 minutes compared with 37.2 ± 15.1 minutes in the conventional group, p = 0.982. Early postoperative scrotal edema was more in the high scrotal group compared to the conventional group, p = 0.018. The Hollander wound evaluation score was better in the high scrotal incision compared to the conventional approach, p = 0.003. The high scrotal approach may be an alternative to conventional herniotomy in boys.

Nuck cyst: a rare cause of inguinal swelling in infancy.

BACKGROUND Inguinal and/or inguino-scrotal swellings, such as hernia and hydrocele, are among the commonest anomalies in childhood. Hydrocele of the canal of Nuck is an uncommon diagnosis and a rare cause of swelling in women that occurs due to a patent vaginal process. METHODS From January 2001 to January 2016, 353 female patients 1-14 years of age were admitted to our university hospital division for inguinal swelling. We have performed 403 inguinal approaches, and of these, 399 (99%) had inguinal hernias, 3 (0.74%) had a cyst of the canal of Nuck, and 1 (0.24%) had a lipoma. All of the patients with Nuck cysts underwent surgical exploration of the swelling through a right inguinal skin crease incision. RESULTS The patients were between the ages of 1 and 8 years. The cyst sizes varied between 25 and 40 mm. All the patients exhibited right, tender, painless, non-reducible masses. In all patients, ultrasound confirmed the suspected diagnosis. The histological findings revealed fibrous-walled cystic formations with mild chronic inflammatory infiltrate that were covered by mesothelial epithelium. The patients' postoperative follow-ups at 1, 6 and 12 months revealed normally healed incisions with no recurrences. CONCLUSIONS The surgical findings and the histological demonstrations of serous epithelium seemed to validate the hypothesis that the patency of the inguinal canal combined with fluid secretion of the peritoneal serosa participated in the formation of the cysts. Surgery with high ligature of the vaginal process is considered the therapy of choice for this pathology.

An Unusual Cause of Sepsis: Infected Iliofemoral Junction False Aneurysm following Extracorporeal Membrane Oxygenation.

The article presents an unusual cause of sepsis happening several weeks after heart transplant (infected iliofemoral junction false aneurysm) requiring iliofemoral reconstruction with arterial homograft by both retroperitoneal and inguinal approaches combined with Sartorius myoplasty.

Safety of two common laparoscopic inguinal herniorrhaphy approaches: an updated systematic review with meta-analysis of randomized clinical trials.

BackgroundPrevious evidence indicated that total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) are advantageous in efficacy of inguinal herniorrhaphy. Therefore, our aim in this study was to evaluate the association of the two laparoscopic approaches on safety of inguinal herniorrhaphy.MethodsIn this update study, we searched the Cochrane Library, EMBASE, PubMed, Scopus, and Web of Science and identified randomized clinical trials comparing complications in TEP and TAPP herniorrhaphy. We mainly used Peto odds ratio with 95% confidence interval (CI) for meta-analysis because of zero-cell.ResultsFourteen eligible trials recruited 659 and 682 patients in TEP and TAPP respectively. In overall pooling, although TEP had a higher seroma rate than TAPP (Peto odds ratio =2.01; 95% CI, 1.39 to 2.91), it had a lower scrotal/cord edema rates at immediate postoperative (Peto odds ratio =0.22; 95% CI, 0.09 to 0.57) and 1 week after inguinal hernia repair (Peto odds ratio =0.58; 95% CI, 0.37 to 0.91) than TAPP.ConclusionsTEP and TAPP have their own advantages in inguinal herniorrhaphy. TAPP was associated with a lower seroma rate, and TEP was associated with a lower edema rate. Therefore, shared decision-making on laparoscopic inguinal herniorrhaphy with TEP and TAPP is still needed.

Варикоцеле: роль в развитии мужского бесплодия и методики хирургического лечения

Varicocele is the most common and treatable cause of male infertility. Therefore, surgical treatment of varicocele should be recommended for motivated patients and infertile couples who do not have other identified causes of infertility. Varicocelectomy has been proved to improve sperm parameters and improve chances of successful conception in most patients. However, surgical treatment is associated with certain risks, and therefore, the choice of the optimal treatment is under discussion. A total of 78 articles using a search in MEDLINE database (PubMed) were found and included in the review, dedicated to current concepts of functional anatomy of testicular arteries and veins. The current recommendations of professional communities regarding the selection of patients for varicocelectomy are described. The efficiency and safety of various surgical procedures for varicocele is analyzed. This review suggests high inconsistences in the literature. The available information on the indications for surgical treatment, as well as comparative data on the efficiency and safety of the inguinal, laparoscopic and microsurgical sub-inguinal approaches are presented. When urologist faces with a diagnosis of varicocele, individual approach should be applied, with a discussion of both benefits and possible complications of surgical treatment. Of the many existing techniques, microsurgical ligation of dilated veins is the most preferred.

Retraction Note: Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

The Editor-in-Chief has retracted this article [1] because it shows significant overlap with a previously published article by Pladzyk et al. [2].

Adolescent de novo hydroceles – should they be dealt with by inguinal or scrotal approach?

AimThe objective of this study was to investigate the optimal approach for the treatment of hydroceles in adolescents. Materials and methodsA retrospective chart review of all adolescents (10–16 years old) diagnosed with a de-novo hydrocele in 2 tertiary care institutions over a 10 year period (2007–2016) was performed comparing the inguinal and trans-scrotal (Jaboulay) approaches. ResultsFifty-three boys with a mean age of 13.4 years (range 10–16 years) were diagnosed with hydrocele. The inguinal approach was used in 31 (59%) patients for treatment of their hydrocele. In 19 (61%) of these cases a patent processus vaginalis (PPV) ligation was performed. In the other 12 (39%) patients the PPV was closed or not found and a further repair of the hydrocele through the same inguinal incision was performed. A transcrotal Jaboulay procedure was performed in 22 (41%) of the patients. There was no difference in the complications rate between inguinal and trans-scrotal approaches (p = 0.71). Age of presentation less than 12 years was associated with the presence of a PPV (p < 0.05). ConclusionsA trans-scrotal approach should be considered as first-line in adolescents when the history is not suggestive of a communicating hydrocele. Children less than 12 years of age are more likely to have a PPV and an inguinal approach may be more appropriate. Type of studyRetrospective comparative study Level of evidenceLevel II.

Nuck cyst: a rare cause of inguinal swelling in infancy.

Inguinal and/or inguino-scrotal swellings, such as hernia and hydrocele, are among the commonest anomalies in childhood. Hydrocele of the canal of Nuck is an uncommon diagnosis and a rare cause of swelling in women that occurs due to a patent vaginal process. From January 2001 to January 2016, 353 female patients 1-14 years of age were admitted to our university hospital division for inguinal swelling. We have performed 403 inguinal approaches, and of these, 399 (99%) had inguinal hernias, 3 (0.74%) had a cyst of the canal of Nuck, and 1 (0.24%) had a lipoma. All of the patients with Nuck cysts underwent surgical exploration of the swelling through a right inguinal skin crease incision. The patients were between the ages of 1 and 8 years. The cyst sizes varied between 25 and 40 mm. All the patients exhibited right, tender, painless, non-reducible masses. In all patients, ultrasound confirmed the suspected diagnosis. The histological findings revealed fibrous-walled cystic formations with mild chronic inflammatory infiltrate that were covered by mesothelial epithelium. The patients' postoperative follow-ups at 1, 6 and 12 months revealed normally healed incisions with no recurrences. The surgical findings and the histological demonstrations of serous epithelium seemed to validate the hypothesis that the patency of the inguinal canal combined with fluid secretion of the peritoneal serosa participated in the formation of the cysts. Surgery with high ligature of the vaginal process is considered the therapy of choice for this pathology.

Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair: an update systematic review and meta-analysis of randomized controlled trials.

Compared with open herniorrhaphy, laparoscopic herniorrhaphy can yield more favorable clinical outcomes. However, previous studies failed to give definite answer for comparison between laparoscopic inguinal hernia repair approaches. This study aimed to systematically determine the differences in recurrence rate, duration of return to work, pain, surgery duration, and duration of hospital stay between transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approach for inguinal hernia. PubMed, Embase, and Cochrane Library (including the Cochrane Central Register of Controlled Trials) abstracts up to September 2017 were searched for randomized controlled trials (RCTs) comparing TAPP or TEP hernia repairing. The hernia recurrence rate, time to return to work, analgesic consumption, surgery duration, hospital stay, and the pain score were recorded with subgroup analysis of the hernia type. Sixteen RCTs that randomized 1519 patients with hernia into TEP and TAPP repair groups were analyzed in this study. The results revealed that TEP repair resulted in shorter hospital stay of primary cases (MD - 0.87, 95% CI - 1.67 to - 0.07) but was associated with a longer operative duration in recurrent hernia group (MD 3.35, 95% CI 0.16 - 6.54). TEP and TAPP have their own advantages. TEP repair reduces short-term postoperative pain more effectively than TAPP repair and results in shorter hospital stay of primary cases. In contrast, TAPP repair is correlated with shorter surgery duration. These findings show that shared decision-making regarding both approaches of laparoscopic hernia repair may be needed.

Inguinal Hernia

Open inguinal hernia approaches are varied. The best studied approaches are reviewed herein. The common factor among them is the imperative anatomy knowledge of the surgeon. This knowledge is key to improved outcomes. A tailored approach is best to determine which open technique, if any, is most appropriate for the patient. Although the anterior mesh approach is the most commonly applied, there is support in using the posterior approach or a tissue repair for subsets of patients, such as women.

Comparative study of inguinal versus scrotal approach in idiopathic vaginal hydrocele.

Background: Hydrocele is a common cause of painless scrotal swelling worldwide.Methods: Hydrocele is a common cause of painless scrotal swelling worldwide. This prospective study was carried out at AVBRH, Sawangi Wardha, Maharashtra, India with the aim of comparing scrotal and inguinal approaches of hydrocelectomy. 100 patients were enrolled between September 2015 and September 2017 and were randomly selected for inguinal and scrotal approaches (n=50 each). They were compared on the basis of volume of hydrocele sac, operative time, post-operative hospital stay, post-operative complications, number of doses of injectable analgesia required and time of return to daily life activity.Results: The patients’ age ranged from 23 to 65 years (42.80±9.73 years) in the inguinal approach group and 22 to 65 years (41.30±11.21 years) in the scrotal approach group. Operative time in the scrotal approach group was less and was associated with more post-operative complications (pain and scrotal edema being frequent), longer hospital stay, increased requirement of injectable analgesia dosage. On the other hand, inguinal approach group had a marginally longer operative time and was associated with less post-operative pain, none to minimal complications, less hospital stay and early return to daily life activities. Conclusions: Thus, hydrocelectomy by inguinal approach is an effective alternative method for the treatment of idiopathic hydrocele.

Classic versus Inguinal Approach for Obturator Nerve Block in Transurethral Resection of Bladder Cancer under Spinal Anesthesia: A Randomized Controlled Trial.

IRCT 201608171772N21.