Bergman's operation for dropsy of the testicle

In modern urology, one of the most popular is the operation of bergman. It has its own specifics, indications and contraindications. Consider the essence of this procedure in more detail. 

Indications for the procedure

The procedure has its own indications for behavior. So, the procedure is performed with dropsy, or hydrocele of the testicle. Dropsy is a common disease characteristic of men. [1]The incidence rate of men with a diagnosis of hydro or spermatocele is 100 per 100,000 men. The frequency of treatment is 17 per 100,000 men. [2]

With this disease, an abnormal accumulation of peritoneal fluid in the vaginal membrane of the scrotum occurs. [3]The disease can be congenital, or acquired. As a rule, the acquired form of the disease manifests itself already in adulthood. Most often, the pathology manifests itself as a result of trauma to the testicle, as a result of the development of a tumor or an inflammatory process. [4]If you do not pay attention to this pathology in a timely manner, and do not take the necessary measures, an inflammatory process develops, which can subsequently develop into a tumor disease. Spermatocele is a complication of dropsy, which is also considered as an indication for surgery. 

The main symptoms of dropsy are considered as the main indications for the operation: hyperthermia (fever), discomfort in the perineum, which is especially aggravated by walking, running, and sudden movements. If the skin of the scrotum is very tight, pain is felt in the scrotum, back surgery is also performed. The indication is rupture of the testicle wall, which leads to severe pain. Also, an indication for surgery is a symptom of fluctuations in the testicles, the essence of which is that when you click on the testicles, the pressure evenly diverges in all directions.

In modern urology, there are several ways to conduct operations. In particular, Bergman surgery is performed under general or local anesthesia. The operation allows you to completely cure the disease. [5]It avoids impotence. There are several varieties of this operation. The main task of the operation is the removal of accumulated fluid. Also, with the help of the operation, it is possible to prevent the development of complications and eliminate the causes of their occurrence. Bergman's operation is based on excision, which is indicated for large tumors, or with a sharp thickening of the testicles.

Preparation

The preparation for Bergman's operation is no different from the standard preparation for any surgical intervention. First of all, it is necessary to pass the set of necessary examinations. First of all, clinical and biochemical analyzes of blood, urine, and blood coagulation analysis will be required. ECG shown, fluorography. If necessary, bacteriological studies are carried out, research on infections, including HIV infection, the causative agent of syphilis. Be sure to consult specialists, including a cardiologist, allergist or immunologist. It is necessary to obtain the conclusion of a pediatrician, or therapist, which will indicate the conclusion about whether the patient can undergo surgery.

When planning general or local anesthesia, it is necessary to consult with an anesthetist, to choose the optimal method of anesthesia. An anesthetist needs a complete history: it is necessary to say about the presence of concomitant diseases, the medications taken, and cases of allergic reactions.

If the operation is not contraindicated, careful preparation is necessary. It begins, as a rule, 2-3 weeks before the planned operation. For 2-3 weeks you need to switch to a balanced diet. It is important to exclude everything fatty, fried, smoked. Marinades, spices, spices, alcohol are strictly contraindicated. Anticoagulants and other drugs are canceled. On the day of surgery, you can neither eat nor drink.

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

During the operation, anesthesia is required. Anesthesia is required, but the method is determined by the doctor. Local or general anesthesia is used. Much depends on the age, severity of the disease, the characteristics of the patient's psycho-emotional state. For older children, general anesthesia is always used.

Technique of the bergman operations

The technique of the Bergman operation is similar to the technique of the Wilkenman operation. The fundamental difference is that during Bergman's surgery, the membranes are excised, while in other cases, the testicle shell is inverted. As a rule, the decision as to which technique is best applied is made by the doctor directly during the operation. After performing the incision and gaining access to the testicles, a complete picture of the pathologists is visible, and this makes it possible to make an adequate decision. With acquired forms of the disease, the volume of fluid can be extremely diverse. In severe cases, a large amount of liquid can accumulate (up to 1.5-2 liters). With 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, in the evening - decreases.

During the operation, the surgeon makes an incision on the scrotum 5-6 cm long. Then, a layered dissection of the testicle membrane occurs. Then it is necessary to turn the testicle into the wound, after which the accumulated fluid is pumped out. After the complete elimination of fluid, the vaginal membrane is dissected, excision of excess tissue occurs. The remains of fabrics are sutured with a catgut. Small stitches are made. After this, the testicle returns to its place, the shells and skin are sutured. There is a complete resorption of the seams. As a rule, sutures dissolve after about 2 weeks.

Operation Lord

Lord's operation is a relatively simple, however, extremely effective procedure aimed at treating dropsy, or testicular hydrocele. However, this procedure is possible with dropsy of small size. In the process, a bag with serous lubricant is dissected. After that, special channels are created through which the elimination of excess fluid occurs. [6], The frequency of isolated hydrocele of the spermatic cord as well as epididymal cysts was lower in patients undergoing the Lord's procedure (7.2 versus 15.8%), as well as the percentage of patients reporting postoperative pain for more than 3 days (4.3 versus 15, 8%, p less than 0.05) compared with traditional surgical procedures. [7] 

Winkelmann operation

During the Winkelmann-Bergman operation, the doctor performs an incision of the skin and outer shells of the testicle. The incision is approximately 5-6 cm. After this, a continuous incision is made, continuing up to the inner vaginal membrane. Then a puncture of the accumulated fluid is done. Inversion of the edges of the wound occurs, then the organs are sutured back. As a result, the shell area is sharply reduced, which will contribute to further absorption of the liquid. Then it is necessary to apply ice to the scrotum, withstand it for at least 2 hours. Various threads can be superimposed, including absorbable and non-absorbable. When using non-absorbable threads, the seams must be removed after about 12-14 hours. [8]

Contraindications to the procedure

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

Consequences after the procedure

After surgery, consequences are rare. Almost all patients who underwent 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 surgery

Complications after the procedure

After Bergman's surgery, complications are possible. Most often, complications such as inflammatory and infectious processes, pain. Perhaps suppuration of the wound, the formation of pus or exudate in the suture area. If you do not observe antiseptics and aseptics, an infection, an inflammatory process can develop. With reduced immunity, or the attachment 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, and sepsis. Septic processes, or blood poisoning, often result in death. A hernia, a discrepancy of sutures in the event that the rehabilitation period is not followed, lift weights, walk a lot in the first days after surgery is also possible. With reduced immunity, the development of an inflammatory or infectious process, the temperature may increase, edema, hyperemia, irritation, itching can develop.

Care after the procedure

After the operation, special postoperative care is required. Firstly, you need to understand that on the day of the operation, a person does not eat anything and not pet. It takes about 3-4 hours to get out of anesthesia. You cannot drink during this time. In extreme cases, with severe thirst, you can moisten the lips, the tip of the tongue with clean water. You can also collect as much saliva in your mouth as possible and moisten your mouth a little. After 3-4 hours, you can start drinking, in small sips. The water should be clean, always non-carbonated, without additives, dyes or flavors. You can drink a broth of wild rose, then you can add a light decoction of chamomile. This will start the stomach, which did not function during the procedure. After 4-5 hours, you can start to eat. The diet should be postoperative (table number 0). It is better to start with low-fat broth (chicken, turkey). Includes mashed soups, mashed cereals, mashed soup, mashed potatoes. By evening, you can light steam cutlets, a piece of boiled meat or fish. About 2-3 days after surgery, you need to adhere to a diet. Food should be light, sparing. Only boiled, steamed or stewed foods should be consumed. Fried, baked dishes are prohibited. Smoked meats, spices, seasonings, marinades, fried and greasy products should be excluded for the entire rehabilitation period. It is also not recommended to use heavy vegetables, sauces. Alcohol is strictly contraindicated.

As the wound heals, the patient is discharged home. At this time, you must strictly follow the doctor’s recommendations. The rehabilitation period in each patient is strictly individual and is determined by the characteristics of the course of the disease, the technique of surgery, age, and physiological characteristics of the patient. Most patients experience improvement after 3-4 days after surgery. For a full 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 lifestyle in 2-3 weeks. In most cases, with the 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 borne in mind that in these 2-3 days, antiseptic treatment of the wound, the application of a sterile dressing, permanent dressings may be required.

Postoperative period

After the operation, the postoperative period must be observed. During the rehabilitation period, both at home and during the hospital stay, the patient is obliged to strictly take all the medicines prescribed by the doctor, follow all the recommendations, treat the wound, apply and change dressings if necessary. It is necessary to wear a special bandage, which will help relieve swelling and inflammation. It should also be borne in mind that in the first days after surgery, swelling and pain in the area of the operation may remain. This helps with a warmer with ice in the area of the operation. Do not wear tight-fitting underwear, tight-fitting or tight underwear. Panties should be made of cotton. Instead of the usual tight-fitting underwear, you should wear a suspensorium - special supportive clothing that relieves excess tension in the groin area. It is necessary to impose drainage.

Physical activity should be sharply limited for at least a week. Intimacy is contraindicated, you should also refuse to drive a car during the rehabilitation period. All active sports, long walking, active activities, must also be excluded. For several days you can neither swim nor bathe. You can’t visit the sauna, bathhouse. After 3-4 days or more, the area of the operation must be treated either with specially prescribed means, or with clean water and a soap solution.

If during the postoperative period pain, swelling, discomfort will bother, you should consult a doctor. Your doctor may prescribe pain medication. After 10 days, a follow-up examination by a urologist is required. An ultrasound examination is performed. In the future, you also need to undergo scheduled inspections. In no case should not be supercool. Overheating is also not recommended.

Reviews

When analyzing reviews, it was 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 operation of the bergman is fast, the postoperative period is short. Soreness and swelling disappears within 2-3 days after the operation. Full recovery occurs in 2-3 weeks. Despite the fact that there are some restrictions after surgery, the postoperative period does not cause severe discomfort. As a rule, in a month a man can return to his usual way of life, restore his intimate life. Only in some cases complications develop. Basically, they develop with improper observance of the rehabilitation period, or with improper execution of the procedure, with the addition of infection.