• Advances in pediatric surgery
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• 제5권1호
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• pp.26-32
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• 1999

We analyzed our experience with orchidopexy for undescended testicle performed during recent 10 years in order to evaluate our results and to determine the most effective treatment of undecended testes. Between 1988 and 1997, we treated 420 undescended tested (314 palpable and 106 nonpalpable) in 356 boys. Medical records were reviewed with respect to age at presentation, the surgical approach, testicular location, testicular volume and the final outcome. The average patient age at presentation was 4.1 years with 40.2 % presenting before age 2 years. Of 106 nonpalpable testes, 23 testes were intra-abdominal, 32 were preperitoneal and 51 were absent. During the first 5 years, we performed orchidopexy through 31 inguinal and 13 midline transabdominal incisions for 44 paitents with nonpalpable testes. In the next 5 years, all 47 patients with nonpalpable were treated through inguinal incisions. For the nonpalpable testes, the inguinal approach with or without intraperitoneal extension was successful in defining the location of testes and blind-ending vessels in all patients. Laparoscopy did not help to avoid surgical exploration in all our patients with nonpalpable tests. Of 339 inguinal and midline tranabdominal orchidopexies without spermatic vessels ligations, 324 testes were placed in the scrotum, 4 in the upper scrotum and 3 in the inguinal area. Eight testes underwent atrophy. Of 13 Fowler-Stephens orchidopexies, 7 were placed in the scrotum and 6 became atrophied. Testicular growths were noticed in most patients who underwent orchidopexies and the colume of pexed testes became as large as the contralateral normal testes by the mean duration of 43.3 months postoperatively. In conclusion, orchidopexies were successful in most cases of cryptochidism in terms of testicular position and growth. However, there were more testicular atrophies in cases where spermatic vessels were ligated. In cases of nonpalpable undescended testes, the inguinal approach with or without intraperitoneal extesion would be recommended.

• Clinical Pain
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• 제18권1호
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• pp.36-39
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• 2019

Chronic postoperative inguinal pain (CPIP) is a major complication after inguinal herniorrhaphy. We report the treatment of CPIP using ultrasonography-combined with nerve stimulator for injection of the genitofemoral nerve (GFN). A 59-year-old man underwent laparoscopic herniorrhaphy and presented with numbness from the inguinal region to the scrotum after operation. In the pain clinic, ultrasonography-guided GFN block and pharmacological treatments had little effect. Six month after operation, patient was referred to the Department of Physical Medicine and Rehabilitation, and ultrasonography-combined with nerve stimulator for GFN injection underwent to enhance the accuracy of neural approach. The induction of scrotal contraction and paresthesia on the GFN distribution was monitored by nerve stimulator and local anesthetic was injected. After the block, pain relief lasted for 6 months without analgesic use. Ultrasonography-combined with nerve stimulator is an effective approach to treat CPIP as it enhances precise localization and injection of small peripheral nerve like GFN.

• Investigative and Clinical Urology
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• 제59권6호
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• pp.416-421
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• 2018

Purpose: Few studies have explored the treatment of isolated communicating hydroceles via scrotal incision. We prospectively evaluated the surgical outcomes of such treatment in boys with hydroceles compared with that using traditional, inguinal incision hydrocelectomy. Materials and Methods: Of 347 boys aged 0-12 years who were diagnosed as hydrocele on ultrasonography, 173 boys were assigned to the scrotal incision hydrocelectomy group (group I, n=173) and 172 boys were assigned to the traditional inguinal incision hydrocelectomy group (group II, n=172), and finally 156 boys in group I and 156 boys in group II were included in this study. Surgical outcomes, including postoperative complications and hydrocele relapse rates, were compared between groups. Results: The overall success rates were similar in both groups (group I, 96.8%; group II, 89.1%; p=0.740). The operation time and hospital stay were significantly shorter in group I ($30.94{\pm}3.95minutes$ and $3.94{\pm}0.30days$) than in group II ($38.02{\pm}7.12minutes$ and $4.24{\pm}0.99days$; p<0.001 and p=0.009, respectively). The postoperative complication rate was lower in group I than in group II (3.2% vs. 10.9%, p=0.740). Conclusions: Scrotal incision hydrocelectomy in boys was associated with shorter operative time and hospital stay, and a lower postoperative complication rate, than was the inguinal incision approach. The scrotal incision technique might be an easy and effective alternative treatment when used to treat hydroceles in boys as well as inguinal incision approach.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7121-7126
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• 2013

Aim: To examine lymph nodes obtained after lipolysis and liposuction of subcutaneous fat of the inguinal region of female vulvar cancer patients to explore the feasibility of clinical application. Methods: The field of operation was on the basis of the range of the conventional resection of inguinal lymph nodes. We injected lipolysis liquid fanwise, started liposuction after 15-20 minutes; then the subcutaneous fatty tissue was sucked out clearly by suction tube. We selected the first puncture holes located on 2-3 cm part below anterior superior spine, the others respectively being located 3cm and 6cm below the first for puncturing into the skin, imbedding a trocar to intorduce $CO_2$ gas and the specular body, and excise the lymph nodes by ultrasonic scalpel. The surgical field chamber was set with negative pressure drainage and was pressured with a soft saline bag after surgery. Results: A lacuna emerged from subcutaneous of the inguinal region after lipolysis and liposuction, with a wide fascia easily exposed at the bottom where lymph nodes could be readily excised. The number of lymph nodes of ten patients excised within the inguinal region on each side was 4-18. The excised average number of lymph nodes was 11 when we had mature technology. Conclusion: Most of adipose tissue was removed after lipolysis and liposuction of subcutaneous tissue of inguinal region, so that the included lymph nodes were exposed and easy to excise by endoscope. This surgery avoided the large incision of regular surgery of inguinal region, the results indicating that this approach is feasible and safe for used as an alternative technology.

• Advances in pediatric surgery
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• 제16권2호
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• pp.101-107
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• 2010

Herniorrhaphy of Indirect inguinal hernia (IIH) is one of the most frequently performed surgical procedures in children. The overall incidence of inguinal hernias in childhood ranges from 0.8 to 4.4 %. The incidence is up to 10 times higher in boys than girls, especially much higher in premature infants. IIHs in children are basically an arrest of embryologic development rather than an acquired weakness, which explains the increased incidence in premature infants. In normal development, the processus vaginalis closes, obliterating the peritoneal opening of the internal ring between 36th and 40th week of gestation. This process is often incomplete, leaving a small patent processus in many newborns. However, closure continues postnatally, and the rate of patency is inversely proportional to age of the child. The presence of a patent processus vaginalis is a necessary but not sufficient variable in developing a congenital IIH. In other words, all congenital IIHs are preceded by a patent processus vaginalis, but not all patent processus vaginalis go on to become IIHs. The overall incidence of IIH in population is approximately 1 to 2 % and the incidence of a processus vaginalis is approximately 12 to 14%, clinically appreciable IIH should develop in approximately 8 to 12 % of patients with a patent processus vaginalis. Although the classic open inguinal hernia repair remains the gold standard for most pediatric surgeons, laparoscopic repair is being performed in many centers. Like open technique, laparoscopic technique is fundamentally a high ligation of the indirect hernia sac with or without internal ring ligation. The advantages of laparoscopic approach include the ease of examining the contralateral internal ring, the avoidance of access damage to vas and vessels during mobilization of cord, decreased operative time, and an ability to identify unsuspected direct or femoral hernias. Almost all groin hernias in children are IIHs and occur as a result of incomplete closure of processus vaginalis. The treatment is repair by high ligation of hernia sac, which can be done by an open or laparoscopic technique. The contralateral side can be explored by laparoscopy or left alone, open exploration is no longer indicated due to potential risk of infertility.

• 한국임상수의학회지
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• 제15권2호
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• pp.303-306
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• 1998

The three cases of cryptorchid are reported here in order to demonstrate the different surgical techniques that were carried out to remove crytochid testes in dogs and to introduce clinical cases on crytorchidism. Three dogs were presented in the clinic of Ecole Veterinaire de Lyon in May, 1998 with two in the left-sided unilateral abdominal cryptorchid and with one in bilateral inguinal mobile cryptorchid. There were two poodle at the age of more than 4 years old and 8 years old respectively with one boxer at 4 years old. In two abdominal cryptotchids, the skin was incised in caudal paramedian approach. Then, the linea alba were incised and cryptorchidectomy was peformed accompaning one with castration and the other with vasectomy by the request of the owners. In inguinal testicles, prescrotal skin incision was made to remove both testicles. The surgical outcome was good without any Their behaviors became agreeable as the proprietors reported. In the dog with vasectomy, the behavior changes were not noticeable.

• Asian Pacific Journal of Cancer Prevention
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• 제16권8호
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• pp.3419-3423
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• 2015

Background: Liposarcoma of the spermatic cord is rare and frequently misdiagnosed. The standard therapeutic approach has been radical inguinal orchiectomy with wide local resection of surrounding soft tissues. The current trend of organ preservation in the treatment of several cancers has started to evolve. Herein we present our testis-sparing surgery experience in the treatment of spermatic cord liposarcoma and a pooled analysis on this topic. Materials and Methods: Clinical information from patient receiving organ-sparing surgery was described. Clinical studies evaluating this issue were identified by using a predefined search strategy, e.g., Pubmed database with no restriction on date of published papers. The literature search used the following terms: epidemiology, surgery, chemotherapy, radiotherapy, testis sparing surgery, spermatic cord sarcomas/liposarcomas. Results: Patient received a complete excision of the lesion, preserving the spermatic cord and the testis. The final pathological report showed a well differentiated liposarcoma with negative surgical margins and no signs of local invasion. After 2-year of follow-up, there was no evidence of local recurrence. Since the first case reported in 1952, a total of about 200 well-documented spermatic cord liposarcoma cases have been published in English literature. Among these patients, only three instances were reported to have received an organ-sparing surgery in the treatment of spermatic cord liposarcoma. Conclusions: Radical inguinal orchiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. But for small, especially well-differentiated, lesions, testis-sparing surgery might be a good option if an adequate negative surgical margin is assured.

• Advances in pediatric surgery
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• 제12권2호
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• pp.155-166
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• 2006

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the "American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)". For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to 'wait and see' until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.

• 한국임상수의학회지
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• 제30권1호
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• pp.66-70
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• 2013

This report compared paramedian and flank approaches for the effective removal of abdominal unilateral cryptorchidism in calves. Two Korean native calves of approximately 300 kg in body weight, which had undergone the removal of a testis from the scrotum, were diagnosed as having abdominal unilateral (left) cryptorchidism by rectal palpation. One calf was administered with xylazine (0.2 mg/kg, IV) and was restrained in the dorsal recumbency position on the ground of barn for the paramedian approach, while the other calf was sedated with xylazine (0.03 mg/kg, IV) and restrained in the standing position for a flank approach. For the two calves, 2% lidocaine was administered by local infiltration, along the proposed incision line. Following incisions of the skin, muscle and peritoneum, the testis, which was located between the left kidney and inguinal canal, was grasped, exteriorized out of the abdominal cavity and detached from the gubernaculum testis. Then spermatic cord was ligated and cut. Finally, the testis was removed. An assistant was required to restraint a calf in dorsal recumbency for paramedian approach, and cryptorchidectomy was carried out with operator in a rather uncomfortable squatting posture, while restraint was rather simple and cryptorchidectomy was proceeded with operator in a standing posture where the flank approach was taken. During surgery, the gubernaculum testis was more strained during pulling the testis in the flank approach than in the paramedian approach, as the distance between incision site and the gubernaculum testis was greater in the flank approach than that in the paramedian approach. On the other hand, intra-abdominal pressure was greater in the paramedian approach than in the flank approach during surgery. The elapsed time between restraint and the end of surgery was 10 min shorter where the flank approach (35 min) was taken, than where the paramedian approach (45 min) was taken. In conclusion, this case study demonstrated that the flank approach might be more convenient than the paramedian approach for abdominal unilateral cryptorchidectomy in calves.

• Advances in pediatric surgery
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• 제19권1호
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• pp.32-38
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• 2013

The purpose of this study is to analyze the early experience of the laparoscopic adhesiolysis for the intestinal obstruction due to postoperative adhesion. Seven patients were included in this study. The median age of those patients was 13, and there were 3 males and 4 females. Previous diagnosis and surgical procedure were various in seven cases, including small bowel resection with tapering enteroplasty, Boix-Ochoa fundoplication, Ladd's procedure with appendectomy, mesenteric tumor resection with small bowel anastomosis, ileocecal resection and anastomosis, primary gastric repair, and both high ligation. A successful laparoscopic adhesiolysis was performed in one who had high ligation for inguinal hernia and had a single band adhesion. Six out of 7 (86%) cases needed to convert open surgery due to multiple and dense type of adhesion. In conclusion, laparoscopic approach with postoperative small bowel adhesion seems safe. However, it might be prudently considered because of high rates of conversion in children.