Concerning sellckchem the outcome of imaging assessment, in group A, there was no significant difference in values of perfusion and size of the testis between preoperative, early postoperative, and late postoperative periods (Figure 5(a)). While in group B; 3 cases (3.3%) had significant diminution of testicular perfusion and size, indicating atrophy (Figure 5(b)). Figure 5 (a) Testicular Doppler U/S showed no signs of ischemia with good blood flow. (b) Testicular Doppler U/S showed poor blood flow. Duplex scan was performed for all male cases preoperatively and postoperatively for detection of significant changes of testicular blood flow. RI index was calculated, using paired t-test, and P values were obtained in group A.

Table 4 clearly shows that there are significant differences (increase of testicular volume) between preoperative and late postoperative volumes of testis units on the operated side in group A, while in group B it clearly shows that there are significant differences (decrease of testicular volume) between preoperative and late postoperative volumes of testis units on the operated side. Table 4 Evaluation of volume of testis in males of both groups. The ratio v was more than 75% in all cases of group A. RI was less than 0.7 in all cases of group A (no atrophy) as shown in Table 5. The ratio v was less than 75% in 3 cases of group B. RI was more than 0.7 in 3 cases of group B (atrophy) as shown in Table 5. Table 5 Duplex evaluation of centripetal artery in males of both groups. 5. Discussion In children, the standard surgical treatment of IH is limited to division and ligation of the hernial sac at the IIR without narrowing the ring [5].

The internal ring normally is reached by dissecting the hernial sac from the cord structures. Open herniotomy is an excellent method of repair in the pediatric population. However, it has the potential risk of injury of the spermatic vessels or vas deferens, hematoma formation, wound infection, iatrogenic ascent of the testis, testicular atrophy, and recurrence of hernia. It also carries the potential risk of tubal or ovarian damage which may cause infertility [12�C14]. Laparoscopic approach is rapidly gaining popularity with more and more studies validating its feasibility, safety, and efficacy [5, 15].

Advantages of laparoscopic inguinal hernia repair include excellent visual exposure, GSK-3 the ability to evaluate the contralateral side, minimal dissection and avoidance of access trauma to the vas deferens and testicular vessels, iatrogenic ascent of the testis, and decreased operative time especially in recurrent and obese cases [3, 5]. However, Alzahem claimed that he is unable to identify any clear benefit of laparoscopic inguinal herniotomy over OH apart from reduction in metachronous hernia development and shorter operative time for bilateral cases [16]. Laparoscopic hernia repair in children is known to take longer operative time than OH.