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Incidence and Clinical Outcomes of Gonadal Artery Injury during Colorectal Surgery in Male Patients

  • Chao-Wen HsuEmail author
  • Min-Chi Chang
  • Jui-Ho Wang
  • Chih-Chien Wu
  • Yu-Hsun Chen
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Abstract

Background

Gonadal artery is susceptible to accidental injury due to their anatomical proximity to the colon and rectum. There are few literature reviews focusing on this injury during colorectal surgery. We conduct a retrospective study to evaluate the incidence and the clinical significance of these injuries in terms of testicular size and testicular enhancement on the contrast CT scan.

Methods

Patients’ characteristic data included age, body mass index (BMI), diagnosis, operation type, cause of gonadal artery injury, side of injury, level of injury, method of vessel ligation, and follow-up period. We measured the testicular sizes before and after gonadal artery injury and measured the enhancement level by recording the mean attenuation value on the injury side and non-injury side of the testis on the CT scan.

Results

The incidence of gonadal artery injury was 3.61% and 15 male patients with this injury were enrolled. There were 5 patients with iatrogenic injury and 10 patients with non-iatrogenic injury due to advanced tumor or inflammation. No patients had any complaints of testicular discomforts or atrophy after the surgery. The testicular sizes before and after the surgery showed no significant difference (p = 0.877). The mean attenuation values of the injury side and non-injury side of the testis also showed no significant difference (p = 0.79).

Conclusions

Gonadal artery injury during colorectal surgery is not a rare complication. To prevent this injury, knowledge of the anatomy and staying in the proper plane of dissection are the key points. In patients with gonadal artery injury during colorectal surgery, sacrifice of the gonadal artery is safe without clinical significance in terms of testicular size and testicular enhancement on the contrast CT scan.

Keywords

Gonadal artery Colorectal Male 

Notes

Acknowledgments

This work was supported by the Kaohsiung Veterans General Hospital, Taiwan (grant KSB108-056). This work was assisted in part by the Division of Colorectal Surgery of the Department of Surgery, Kaohsiung Veterans General Hospital.

Author Contribution

Chao-Wen Hsu: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; statistical analysis. Min-Chi Chang, Chih-Chien Wu, Yu-Hsun Chen: acquisition of data. Jui-Ho Wang: critical revision of the manuscript for import ant intellectual content.

Compliance with Ethical Standards

Disclosures Chao-Wen Hsu MD, Min-Chi Chang MD, Jui-Ho Wang MD,

Chih-Chien Wu MD, Yu-Hsun Chen MD declare that they have no conflict of interest.

References

  1. 1.
    Bothwell, W.N., R.J. Bleicher, and T.L. Dent, Prophylactic ureteral catheterization in colon surgery. A five-year review. Dis Colon Rectum, 1994. 37(4): p. 330-4.CrossRefGoogle Scholar
  2. 2.
    Kyzer, S. and P.H. Gordon, The prophylactic use of ureteral catheters during colorectal operations. Am Surg, 1994. 60(3): p. 212-6.Google Scholar
  3. 3.
    Delacroix, S.E., Jr. and J.C. Winters, Urinary tract injures: recognition and management. Clin Colon Rectal Surg, 2010. 23(2): p. 104-12.CrossRefGoogle Scholar
  4. 4.
    Chan, P.T., E.J. Wright, and M. Goldstein, Incidence and postoperative outcomes of accidental ligation of the testicular artery during microsurgical varicocelectomy. J Urol, 2005. 173(2): p. 482-4.CrossRefGoogle Scholar
  5. 5.
    Cuda, S.P., et al., Incidence and clinical significance of arterial injury in varicocele repair. BJU Int, 2011. 107(10): p. 1635-7.CrossRefGoogle Scholar
  6. 6.
    Yamamoto, M., et al., Comparison of artery-ligating and artery-preserving varicocelectomy: effect on post-operative spermatogenesis. Andrologia, 1995. 27(1): p. 37-40.CrossRefGoogle Scholar
  7. 7.
    Matsuda, T., Y. Horii, and O. Yoshida, Should the testicular artery be preserved at varicocelectomy? J Urol, 1993. 149(5 Pt 2): p. 1357-60.CrossRefGoogle Scholar
  8. 8.
    Yu, W., et al., Laparoscopic Varicocelectomy in Adolescents: Artery Ligation and Artery Preservation. Urology, 2016. 89: p. 150-4.CrossRefGoogle Scholar
  9. 9.
    Global Health Observatory (GHO) data of Body Mass Index. World Health Organization, 2018.Google Scholar
  10. 10.
    Althumairi, A.A. and J.E. Efron, Genitourinary Considerations in Reoperative and Complex Colorectal Surgery. Clin Colon Rectal Surg, 2016. 29(2): p. 145-51.CrossRefGoogle Scholar
  11. 11.
    Halabi, W.J., et al., Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Dis Colon Rectum, 2014. 57(2): p. 179-86.CrossRefGoogle Scholar
  12. 12.
    Andersen, P., L.M. Andersen, and L.H. Iversen, Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches. Surg Endosc, 2015. 29(6): p. 1406-12.CrossRefGoogle Scholar
  13. 13.
    Rose, J., et al., Complications in laparoscopic colorectal surgery: results of a multicentre trial. Tech Coloproctol, 2004. 8 Suppl 1: p. s25-8.CrossRefGoogle Scholar
  14. 14.
    Alizadeh, R.F., et al., Body Mass Index Significantly Impacts Outcomes of Colorectal Surgery. Am Surg, 2016. 82(10): p. 930-935.Google Scholar
  15. 15.
    Lamba, R., et al., CT Hounsfield Numbers of Soft Tissues on Unenhanced Abdominal CT Scans: Variability Between Two Different Manufacturers’ MDCT Scanners. AJR. American journal of roentgenology, 2014. 203(5): p. 1013-1020.CrossRefGoogle Scholar
  16. 16.
    Zollinger, R.M., Testicular Atrophy, in Abdominal Wall Hernias: Principles and Management, R. Bendavid, et al., Editors. 2001, Springer New York: New York. p. 179-183.CrossRefGoogle Scholar
  17. 17.
    Kayalvizhi, I., R.K. Narayan, and P. Kumar, Anatomical variations of testicular artery: a review. Folia Morphol (Warsz), 2017.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Chao-Wen Hsu
    • 1
    • 2
    Email author
  • Min-Chi Chang
    • 1
  • Jui-Ho Wang
    • 1
  • Chih-Chien Wu
    • 1
  • Yu-Hsun Chen
    • 1
  1. 1.Division of Colorectal Surgery, Department of SurgeryKaohsiung Veteran General HospitalKaohsiungRepublic of China
  2. 2.Faculty of MedicineNational Yang-Ming UniversityTaipei CityTaiwan

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