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Iatrogenic vas deferens injury due to inguinal hernia repair

  • Review Article
  • Published:
Hellenic Journal of Surgery

Abstract

Aim-Background

One of the most common operations performed by general and paediatric surgeons is that of inguinal hernia repair. A rare complication of this surgery is injury to the vas deferens (vas), regardless of the surgical technique used. The aim of this article is to review current data regarding the consequences following vas injury and to provide surgeons, who operate in the inguinal canal, with all the current knowledge regarding appropriate treatment of the injured vas.

Methods

A systematic search was conducted through Pubmed, Embase, OVID, Medline, Cinahl and Google search engines to identify relevant reports.

Results

Vas injury can be the result of intraoperative manipulations or can be related to the mesh used for hernioplasty. A 0.1–0.53 % incidence of vas injury is reported in open inguinal hernia repairs. The most common consequences are spermatic granuloma formation, vas and epididymal epithelium dysfunction and testicular atrophy, unilateral or bilateral. The mechanism of bilateral testicular damage is mediated through the formation of sperm autoantibodies and sympathetic orchiopathia. The optical loupe-assisted modified one-layer anastomosis technique yields overall similar patency rates when compared with microsurgical techniques, and also has positive outcomes in terms of shorter operative time, less infrastructure and lower cost.

Conclusions

Immediate management of the injured vas requires a broad understanding of the consequences, advanced surgical skills, and liaison with specialists in this field. A therapeutic algorithm is proposed by the authors of this article.

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Authors and Affiliations

  1. Department of General Surgery, General Hospital of Drama, End of Hippokratous Street, 66100, Drama, Greece

    K. Blouchos, K. A. Boulas, D. G. Tselios & A. Hatzigeorgiadis

  2. Department of Urology, General Hospital of Drama, End of Hippokratous Street, 66100, Drama, Greece

    P. Kirtsis

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  1. K. Blouchos
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  2. K. A. Boulas
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Correspondence to K. Blouchos.

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Blouchos, K., Boulas, K.A., Tselios, D.G. et al. Iatrogenic vas deferens injury due to inguinal hernia repair. Hellenic J Surg 84, 356–363 (2012). https://doi.org/10.1007/s13126-012-0052-7

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