Ligation Of Spermatic Cord Research Articles

Percutaneous endoscopic external ring (PEER) hernioplasty

This pilot study was conducted to determine if percutaneous endoscopic external ring (PEER) hernioplasty would be a viable alternative to the conventional and laparoscopic methods of tension-free repair. The procedure consists of (1) a 2.0-2.5-cm incision over the external inguinal ring to reach the emerging spermatic cord structures, and ligation and excision of the hernia sac and (2) insertion of an endoscope-attached retractor through the external ring, into the inguinal canal for visualization, dissection of posterior inguinal wall, and placement of mesh to complete tension-free repair. PEER hernioplasty was used to treat 48 patients with 60 primary hernias (bilateral in 12 patients) between January 1993 and December 1994. Median follow-up was 12 months and ranged from 5 to 22 months. All patients were discharged within 24 h after surgery except for one. All patients resumed their normal activity within 2-3 weeks. Only three complications were encountered (two scrotal hematomas and one inguinal seroma). To date, there has been recurrence of two hernias in one patient. We conclude that PEER hernioplasty is an effective method of repair of primary hernias that is less invasive than the conventional approach and both less invasive and more cost-effective than laparoscopic approaches.

Doppler contrast sonography for detecting reduced perfusion in experimental ischemia of prepubertal rabbit testes.

We examined whether the intravenous (IV) Doppler ultrasound contrast agent SHU 508 would improve the detection of reduced perfusion of rabbit testes when normal flow was otherwise difficult to detect. Seventeen anesthetized prepubertal rabbits underwent random unilateral spermatic cord ligation and a contralateral sham operation. Immediate, blinded, and systematic color Doppler examination of each pair of testes was recorded before and after IV administration of 1 ml (300 mg) SHU 508, a gas-containing microparticle. Recorded examinations were reviewed by two pediatric radiologists who were unaware of experimental conditions and who graded intratesticular flow. For 34 pairs of observations (17 animals x 2 observers), intratesticular flow was absent in the sham-operated testes in 18 precontrast and two postcontrast images. The false-positive rate in this group decreased from 53% to 6%. This improvement in the detection of normal blood flow was statistically significant. The absence of flow in the ischemic testis was not significantly different before or after contrast agent administration. IV SHU 508 enhances color Doppler ultrasound detection of flow not otherwise evident in prepubertal rabbit testes. Doppler ultrasound contrast agents may be used in a setting of suspected torsion when routine Doppler sonography is indeterminate.

Assessment of xylazine hydrochloride epidural analgesia for open castration of rams

Epidural xylazine injected at the sacrococcygeal site 40 to 150 min prior to surgery (at a dose of 0.05 to 0.10 mg/kg) provided good analgesia during scrotal skin incision in all 20 experimental rams but in only 10 rams (50%) at incision and separation of tunica vaginalis, and 6 rams (30%) during ligation of the spermatic cord. There was a significant correlation between the decrease in heart rate and the dosage of epidural xylazine. Heart rate increased significantly during incision of the tunics and spermatic cord ligation but was not significantly correlated to the clinical assessment of analgesia. There was no significant correlation between the presence of surgical analgesia and the dosage of epidural xylazine: Pelvic limb ataxia was still evident in 12 rams (60%) at 8 h after epidural xylazine injection. Epidural xylazine provided good somatic analgesia during open castration of 20 rams but visceral analgesia was unpredictable. Factors in addition to the dosage of sacrococcygeal epidural xylazine affects the degree of surgical analgesia obtained for open castration of rams.

Testicular oximetry: A new method for the assessment of tissue perfusion and viability following torsion and detorsion

This study evaluated the use of a polarographic surface PO2 electrode to assess testicular perfusion and viability following torsion and detorsion. Adult male Sprague-Dawley rats were divided into groups and subjected to unilateral testicular torsion and detorsion of varying degrees and durations. Rats subjected to sham torsion or 720 degrees torsion did not show significant decreases in testicular PO2 after 15 minutes, whereas those subjected to 1,080 degrees torsion or spermatic cord ligation uniformly decreased their testicular PO2 to 0 mm Hg within 10 minutes. Testicular PO2 values were similar in rats subjected to 60 minutes of 720 degrees torsion followed by detorsion and those undergoing 15 minutes of 1,080 degrees torsion and detorsion. Rats subjected to breathing 100% oxygen uniformly increased their testicular PO2 to an average of more than twice room-air values. However, rats subjected to 1,080 degrees torsion for 6 hours followed by detorsion did not increase their testicular PO2 when subjected to breathing 100% oxygen, whereas those subjected to 720 degrees torsion for 6 hours followed by detorsion did increase their testicular PO2 when subjected to breathing 100% oxygen. The latter rats did not show microscopic changes associated with acute testicular infarction, whereas the former did.(ABSTRACT TRUNCATED AT 250 WORDS)