Bergman surgery for testicular hydrocele.

In modern urology, one of the most popular is the Bergman operation. It has its own specifics, indications and contraindications. Let's consider the essence of this procedure in more detail.

Indications for the procedure

The procedure has its own indications for behavior. Thus, the procedure is carried out for dropsy, or hydrocele of the testicle. Dropsy is a common disease, typical for men. [ 1 ] The incidence of men diagnosed with hydrocele or spermatocele is 100 per 100,000 men. The frequency of treatment is 17 per 100,000 men. [ 2 ]

This disease is characterized by abnormal accumulation of peritoneal fluid in the vaginal membrane of the scrotum. [ 3 ] The disease can be congenital or acquired. As a rule, the acquired form of the disease manifests itself in adulthood. Most often, the pathology manifests itself as a result of injury to the testicle, as a result of the development of a tumor or an inflammatory process. If this pathology is not paid attention to in a timely manner and the necessary measures are not taken, an inflammatory process develops, which can subsequently develop into a tumor disease. Spermatocele is a complication of dropsy, which is also considered an indication for surgery.

The main indications for surgery are the main symptoms of hydrocele: hyperthermia (increased body temperature), discomfort in the perineum, which is especially aggravated by walking, running, and sudden movements. If the skin of the scrotum is very stretched, pain is felt in the scrotum, and the back is also operated on. An indication is a rupture of the testicular wall, which leads to severe pain. Another indication for surgery is the symptom of fluctuation in the testicles, the essence of which is that when pressing on the testicles, the pressure is evenly distributed in all directions.

In modern urology, there are several ways to perform surgeries. In particular, the Bergman operation is performed under general or local anesthesia. The operation allows you to completely cure the disease. [ 4 ] It allows you to avoid impotence. There are several types of this operation. The main goal of the operation is to remove the accumulated fluid. Also, with the help of surgery, you can prevent the development of complications, eliminate the causes of their occurrence. The Bergman operation is based on excision, which is indicated for large tumors, or with a sharp thickening of the testicular membranes.

Preparation

Preparation for the Bergman operation is no different from standard preparation for any surgical intervention. First of all, it is necessary to pass a set of necessary examinations. First of all, clinical and biochemical blood and urine tests, blood clotting test are required. ECG and fluorography are indicated. If necessary, bacteriological studies are carried out, studies for infections, including HIV infection, the causative agent of syphilis. Consultations with specialists are required, including a cardiologist, allergist or immunologist. It is necessary to obtain a conclusion from a pediatrician or therapist, which will indicate whether the patient can undergo surgery.

When planning general or local anesthesia, it is necessary to consult with an anesthesiologist and choose the best method of anesthesia. The anesthesiologist definitely needs a full anamnesis: it is necessary to mention the presence of concomitant diseases, medications taken, and cases of allergic reactions.

If the operation is not contraindicated, careful preparation is necessary. It usually begins 2-3 weeks before the planned operation. 2-3 weeks before, you need to switch to a balanced diet. It is important to exclude all fatty, fried, smoked foods. Pickles, spices, seasonings, alcohol are strictly contraindicated. Anticoagulants and other medications are canceled. On the day of the operation, you cannot eat or drink anything.

Also on the day of the operation, it is necessary to thoroughly wash the genitals. In the pubic and groin area, it is necessary to remove hair. If the operation is performed on an adult, he does it at home on his own. If the procedure is performed on a child, all necessary preparatory measures are carried out by medical personnel.

Anesthesia is required during the operation. Anesthesia is mandatory, but the method of its administration is determined by the doctor. Local or general anesthesia is used. Much depends on the age, severity of the disease, and the characteristics of the patient's psycho-emotional state. General anesthesia is always used for older children.

Technique Bergman operations

The Bergman operation technique is similar to the Wilkenman operation technique. The fundamental difference is that the Bergman operation involves excision of the membranes, while in other cases the testicular membrane is everted. As a rule, the decision regarding which technique is best to use is made by the doctor directly during the operation. After making an incision and gaining access to the testicles, a complete picture of the pathology is visible, and this makes it possible to make an adequate decision. In acquired forms of the disease, the volume of fluid can be extremely varied. In severe cases, a large amount of fluid can accumulate (up to 1.5-2 liters). In congenital pathologies, the amount of fluid can vary depending on the time of day. As a rule, in the morning the amount of fluid increases sharply, and in the evening it decreases.

During the operation, the surgeon makes a 5-6 cm long incision on the scrotum. Then the testicle membrane is dissected layer by layer. Then it is necessary to turn the testicle into the wound, after which the accumulated fluid is pumped out. After the fluid has been completely removed, the vaginal membrane is dissected, and excess tissue is excised. The remaining tissue is sutured with catgut. Small stitches are made. After this, the testicle is returned to its place, and the membranes and skin are sutured. The stitches are completely absorbed. As a rule, the stitches dissolve in about 2 weeks.

Operation Lord

The Lord procedure is a relatively simple, yet highly effective procedure for treating testicular hydrocele. However, this procedure is only possible for small hydrocele cases. The procedure involves cutting the serous sac. Channels are then created to allow the excess fluid to drain. [ 5 ] The incidence of isolated spermatic cord hydrocele and epididymal cysts was lower in patients who underwent the Lord procedure (7.2 vs. 15.8%), as was the percentage of patients reporting postoperative pain for more than 3 days (4.3 vs. 15.8%, p < 0.05) compared to traditional surgical procedures. [ 6 ]

Winkelmann operation

During the Winkelmann-Bergmann operation, the doctor makes an incision in the skin and outer membranes of the testicle. The incision is approximately 5-6 cm. After this, a continuous incision is made, continuing all the way to the inner vaginal membrane. Then a puncture of the accumulated fluid is made. The edges of the wound are everted, then the organs are sutured from behind. As a result, the area of the membrane is sharply reduced, which will facilitate further absorption of fluid. Then it is necessary to apply ice to the scrotum, keep it for at least 2 hours. Various threads can be applied, including absorbable and non-absorbable. When using non-absorbable threads, the stitches must be removed after approximately 12-14 hours. [ 7 ]

Contraindications to the procedure

There are no specific contraindications to the operation. They are all standard and do not differ from contraindications to any surgical intervention. For example, the Bergman operation, like any other surgical intervention, is strictly contraindicated in various serious pathologies of the kidneys, liver, cardiovascular system, in case of respiratory dysfunction, hypertension, vascular tone disorder. The procedure is also contraindicated in case of intolerance to anesthesia, severe allergic reactions, increased sensitization of the body, acute inflammatory and infectious pathologies. The operation is not performed in case of exacerbation of chronic diseases, relapses, colds, severe forms of diabetes mellitus, blood clotting disorders, hemophilia, while taking anticoagulants.

Consequences after the procedure

After the operation, consequences are rarely observed. Almost all patients who have undergone this procedure note that after the operation, the condition improves significantly, pain and discomfort cease to bother the person. In the first few days after the operation

Complications after the procedure

Complications are possible after the Bergman operation. The most common complications are inflammatory and infectious processes, pain. Wound suppuration, pus or exudate formation in the suture area are possible. If antisepsis and asepsis are not observed, an infection or inflammatory process may develop. With reduced immunity, or the addition of an infection, especially hospital strains of microorganisms, the inflammatory-infectious process can progress to the development of a severe inflammatory process, tissue necrosis, bacteremia, sepsis. Septic processes, or blood poisoning, often end in death. A hernia, suture divergence are also possible if the rehabilitation period is not observed, heavy objects are lifted, a lot of walking is done in the first days after the operation. With reduced immunity, the development of an inflammatory or infectious process, the temperature may rise, edema, hyperemia, irritation, itching may develop.

Care after the procedure

After the operation, special postoperative care is required. First, you need to understand that on the day of the operation, a person does not eat or drink anything. It takes about 3-4 hours to come out of anesthesia. During this time, you cannot drink. In extreme cases, if you are very thirsty, you can moisten your lips and the tip of your tongue with clean water. You can also collect as much saliva as possible in your mouth and moisten your mouth little by little. After 3-4 hours, you can start drinking, in small sips. The water should be clean, necessarily non-carbonated, without additives, dyes and flavors. You can drink rosehip broth, then you can add a light chamomile decoction. This will start the stomach, which did not function during the procedure. After 4-5 hours, you can start eating. The diet should be postoperative (table No. 0). It is better to start with low-fat broth (chicken, turkey). Includes strained soups, strained porridges, cream soup, mashed potatoes. In the evening, you can have light steamed cutlets, a piece of boiled meat or fish. For about 2-3 days after the operation, you need to stick to a diet. The food should be light, gentle. It is necessary to eat only boiled, steamed or stewed dishes. Fried, baked dishes are prohibited. Smoked foods, spices, seasonings, marinades, fried and fatty products should be excluded for the entire rehabilitation period. It is also not recommended to eat heavy vegetables and sauces. Alcohol is strictly contraindicated.

As the wound heals, the patient is discharged home. At this time, it is necessary to strictly follow the doctor's recommendations. The rehabilitation period for each patient is strictly individual and is determined by the characteristics of the course of the disease, the technique of the operation, age, and physiological characteristics of the patient. Most patients experience an improvement in their condition within 3-4 days after the operation. For a complete recovery of the body, it takes from one to several months. However, if you strictly follow all the doctor's recommendations, you can return to your usual way of life in 2-3 weeks. In most cases, with a normal course of the rehabilitation period, additional assistance and hospitalization are not required. Therefore, after 2-3 days, the patient can be discharged home. It should be taken into account that during these 2-3 days, antiseptic treatment of the wound, the application of a sterile bandage, and constant dressings may be required.

Postoperative period

After the operation, it is necessary to observe the postoperative period. During the rehabilitation period, both at home and during the hospital stay, the patient must strictly take all medications prescribed by the doctor, follow all recommendations, treat the wound, apply and change bandages if necessary. It is necessary to wear a special bandage, which will help relieve swelling and inflammation. It is also necessary to take into account that in the first days after the operation, swelling and pain in the area of the operation may persist. A heating pad with ice in the area of the operation helps. You should not wear tight-fitting underwear, tight or tight underwear. Panties should be made of cotton fabric. Instead of regular tight underwear, you need to wear a suspensory - special support clothing that relieves excess tension in the groin area. It is necessary to apply drainage.

Physical activity should be severely limited for at least a week. Intimate closeness is contraindicated, and driving a car should also be avoided during the rehabilitation period. All active sports, long walks, and active activities should also be excluded. For several days, neither swimming nor washing should be allowed. Visiting a sauna or bathhouse is prohibited. After 3-4 days or more, the area of the operation should be treated either with specially prescribed products or with clean water and soap solution.

If you experience pain, swelling, or discomfort during the postoperative period, you should see a doctor. The doctor may prescribe painkillers. After 10 days, a follow-up examination by a urologist is required. An ultrasound examination is performed. In the future, you will also need to undergo routine examinations. In no case should you become overcooled. Overheating is also not recommended.

Reviews

When analyzing the reviews, we found that positive reviews prevail. Patients note that the operation significantly alleviates the condition, eliminates pain, discomfort, pressure in the scrotum and testicles. Basically, the Bergman operation is fast, the postoperative period is short. Pain and swelling disappear within 2-3 days after the operation. Full recovery occurs in 2-3 weeks. Despite the fact that there are some restrictions after the operation, the postoperative period does not cause severe discomfort. As a rule, a man can return to his usual way of life and restore his intimate life in a month. Only in some cases do complications develop. They mainly develop with improper observance of the rehabilitation period, or with improper performance of the procedure, with the addition of an infection.