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Hernia
Published in: Hernia 6/2017

01-12-2017 | Original Article

Bilateral endoscopic totally extraperitoneal (TEP) inguinal hernia repair does not impair male fertility

Authors: M. M. Roos, G. J. Clevers, E. J. Verleisdonk, P. H. Davids, C. van de Water, R. J. Spermon, L. S. Mulder, J. P. J. Burgmans

Published in: Hernia | Issue 6/2017

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Abstract

Purpose

Endoscopic totally extraperitoneal (TEP) hernia repair with polypropylene mesh has become a well-established technique. However, since the mesh is placed in close contact with the spermatic cord, mesh-induced inflammation may affect its structures, possibly resulting in impaired fertility. The aim of this observational prospective cohort study was to assess fertility after bilateral endoscopic TEP inguinal hernia repair in male patients.

Methods

Fifty-seven male patients (22–60 years old) with primary, reducible, bilateral inguinal hernias underwent elective bilateral endoscopic TEP hernia repair with use of polypropylene mesh. The primary outcome was testicular perfusion; secondary outcomes were testicular volume, endocrinological status, and semen quality. All patients were assessed preoperatively and 6 months postoperatively.

Results

Follow-up was completed in 44 patients. No statistically significant differences in measurements of testicular blood flow parameters or testicular volume were found. Postoperative LH levels were significantly higher [preoperative median 4.3 IU/L (IQR 3.4–5.3) versus postoperative median 5.0 IU/L (IQR 3.6–6.5), p = 0.03]. Levels of inhibin B were significantly lower postoperatively [preoperative median 139.0 ng/L (IQR 106.5–183.0) versus postoperative median 27.0 ng/L (IQR 88.3–170.9), p = 0.01]. No significant changes in FSH or testosterone levels were observed. There were no differences in semen quality.

Conclusions

Our data suggest that bilateral endoscopic TEP hernia repair with polypropylene mesh does not impair fertility, as no differences in testicular blood flow, testicular volume, or semen quality were observed. Postoperative levels of LH and inhibin B differed significantly from preoperative measurements, yet no clinical relevance could be ascribed to these findings.
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Metadata
Title
Bilateral endoscopic totally extraperitoneal (TEP) inguinal hernia repair does not impair male fertility
Authors
M. M. Roos
G. J. Clevers
E. J. Verleisdonk
P. H. Davids
C. van de Water
R. J. Spermon
L. S. Mulder
J. P. J. Burgmans
Publication date
01-12-2017
Publisher
Springer Paris
Published in
Hernia / Issue 6/2017
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-017-1657-0

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Comment

Comment to: “Long-term retromuscular and intraperitoneal mesh size changes within a randomized controlled trial on incisional hernia repair, including a review of the literature.” Rogmark P., Ekberg O, Montgomery A.