The risk of communicating TEP-related infertility risk is an opportunity and not a “Cinderella concern” any more

Excerpt

Congratulations to our Editors on promoting publications aimed at improving outcomes of surgical procedures. It speaks volumes of their professional acumen as well as social responsibility. Totally extraperitoneal (TEP) inguinal herniorrhaphy has gained acceptability as a cost-effective standard-of-care procedure with all the inherent advantages of minimally invasive surgery [1]. Polypropylene (PP)-based meshes have been integral to effectiveness of this procedure. Biocompatibility of PP-based meshes continues to challenge the scientific demeanor of the surgeon. Two recently published works have dwelt on this challenge [2, 3]. These articles have indicated improved biocompatibility with reduced PP content. While inflammatory response is muted, its markers are detectable even years later [3]. The persistent inflammatory response and resultant cicatrization has potential to insult the contiguous structures including vas, leading to functional obstruction and spermatozoid repression [4]. This PP-mesh-induced response to the structures of the spermatic cord [5] is discouraging in the context of reported improvement in testicular function after herniorrhaphy [6]. The anticipated improvement in testicular function attributed to vascular dynamics [6] also becomes doubtful in light of the possibility of prosthesis-induced vascular insult [7]. …