Kristin A. Sonderman1,2 · Lindsey L.

Wolf1,2 ·
Lindsey B. Armstrong3 · Kathryn Taylor4 , et al.

Testicular Atrophy Following Inguinal

Hernia Repair in Children
TOPIC

Material and Result

Introduction
Methods

Discussion Conclusion
Introduction
Inguinal hernias occur in 1–5% of all newborns and are
one of the most frequently diagnoses in pediatric
surgery
Premature
with low
birth
weight Testicular atrophy
is one of
complication,
reported to occur
in 0.1–1.2% of
inguinal hernia
Children cases
with
undescen
ded testis
Material and Methods
This is a retrospective cohort study utilizing the
Department of Defense Military Health System Data
Repository (MDR).

Participants are followed as long as they are enrolled

in the TRICARE health insurance program.

For this study, data were abstracted over the time

period 2005–2014.
Study population and classification of outcomes
No Inclusion Criteria Exclusion criteria
1. All male children < 12 years of age Patients with history of testicular
who underwent inguinal hernia atrophy or testicular torsion prior to
repair. surgery, prior testicular operations,
testicular malignancy, or lymphoma.
2. Defined by International Children who had an orchiectomy at
Classification of Diseases, 9th the time of the initial inguinal hernia
Revision, clinical modification repair.
(ICD9-CM) procedure codes or
(CPT) codes
3. Children who underwent an
orchiectomy, with the primary
diagnosis of testicular atrophy
Primary outcome  Diagnosis of testicular atrophy following
inguinal hernia repair.
Patient Demographic characteristics, including age,
race/ethnicity, and history of prematurity (using ICD-
characteristics 9CM diagnosis codes)

Location of the patient’s careas “direct care” for

patients receiving care at a military hospital and
“purchased care” for patients receiving care at a
civilian hospital.
Statistical analysis

compared
Calculated categorical
incidence of variables with
testicular chi-squared or
Described Fisher exact
these atrophy for the
overall tests.
characteristics
who did and population
stratified by undergoing
the presence did not
develop inguinal hernia
of repair as well
undescended testicular
atrophy during as stratified by
First testis at the age,
described time of the study
period undescended
patient repair. testis, and
characteris surgeon
tics for the specialty
study
population
RESULT
RESULT

Overall Incidence of testicular atrophy was 5.1/10,000 person-years,

with the highest incidence in those with an undescended
testis (13.9/10,000 person-years). All cases occurred in
children ≤ 5 years, with 72% in children < 2 years. Median
time to atrophy was 2.4 years (IQR 0.64–3), with 30%
occurring within 1 year and 75% within 3 years.
DISCUSSION
 9000 children with 18 children diagnosed
inguinal hernia repaired with testicular atrophy
 with UDT Non UDT
13.9 2.8
cases/10,000 cases/10,000
person-years person-years

The majority occurrences of testicular atrophy were in

children < 2 years, corresponding to an incidence of 9.9
cases per 10,000 person-years in this age group.

These results support and advance the current literature

 Younger children are Higher rates of atrophy
particularly at risk for have been reported in
testicular ischemia due the populationof children
to the lack of collateral undergoing repair of
blood flow incarcerated hernias

Undescended testis as a
risk factor for testicular
higher risk of cord injury
infarction in children
on Hernia Strangulated
undergoing inguinal
hernia repair
• This study is • To minimize the • It is possible that
susceptible to possibility of some
limitations miscoded data, hydrocelectomies
consistent with we required two were coded as
using a claims diagnosis codes hernia repairs;
database, to define our however, those
including limited primary outcome. with
access to clinical communicating
variables, the risk hydroceles
of miscoding, and would still be at
missing data. risk for testicular
atrophy.
This cohort to date of children undergoing inguinal
hernia repair, with extensive follow-up time including
both inpatient and outpatient care provided. The
perpouse is present incidence of testicular atrophy are
clinically relevant for preoperative counseling and
operative planning, allowing surgeons to provide
accurate risk assessments to parents.

In addition, the description of the timing of this

complication is relevant to inform primary care
providers about the need for ongoing monitoring in
these patients, as we found that atrophy may be
diagnosed as late as 6 years following repair.
Conclusion
Testicular atrophy is a rare complication
following inguinal hernia repair. We found
children < 2 years and children with an
undescended testis to be at the highest risk.
While 30% of cases were diagnosed within
the first year, testicular atrophy may also be
diagnosed substantially later.
ThankYou
Terima Kasih