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Reproductive Health
Published in: Reproductive Health 1/2018

Open Access 01-12-2018 | Review

Does the use of hernia mesh in surgical inguinal hernia repairs cause male infertility? A systematic review and descriptive analysis

Authors: Zhiyong Dong, Stacy Ann Kujawa, Cunchuan Wang, Hong Zhao

Published in: Reproductive Health | Issue 1/2018

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Abstract

Objective

The aim of this study was to systematically review the available clinical trials examining male infertility after inguinal hernias were repaired using mesh procedures.

Methods

The Cochrane Library, PubMed, Embase, Web of Science, and Chinese Biomedical Medicine Database were investigated. The Jada score was used to evaluate the quality of the studies, “Oxford Centre for Evidence-based Medicine-Levels of Evidence” was used to assess the level of the trials, and descriptive analysis was used to evaluate the studies.

Results

Twenty nine related trials with a total of 36,552 patients were investigated, including seven randomized controlled trials (RCTs) with 616 patients and 10 clinical trials (1230 patients) with mesh or non-mesh repairs. The Jada score showed that there were six high quality RCTs and one low quality RCT. Levels of evidence determined from the Oxford Centre for Evidence-based Medicine further demonstrated that those six high quality RCTs also had high levels of evidence. It was found that serum testosterone, LH, and FSH levels declined in the laparoscopic group compared to the open group; however, the testicular volume only slightly increased without statistical significance. Testicular and sexual functions remained unchanged after both laparoscopic transabdominal preperitoneal hernia repair (TAPP) and totally extra-peritoneal repair (TEP). We also compared the different meshes used post-surgeries. VyproII/Timesh lightweight mesh had a diminished effect on sperm motility compared to Marlex heavyweight mesh after a one-year follow-up, but there was no effect after 3 years. Additionally, various open hernia repair procedures (Lichtenstein, mesh plug method, posterior pre-peritoneal mesh repair, and anterior tension-free repair) did not cause infertility.

Conclusions

This systematic review suggests that hernia repair with mesh either in an open or a laparoscopic procedure has no significant effect on male fertility.
Literature
1.
2.
Zulu HG, Mewa Kinoo S, Singh B. Comparison of Lichtenstein inguinal hernia repair with the tension-free Desarda technique: a clinical audit and review of the literature. Trop Dr. 2016;46(3):125–9.
3.
Wei FX, Zhang YC, Han W, Zhang YL, Shao Y, Ni R. Transabdominal Preperitoneal (TAPP) versus totally Extraperitoneal (TEP) for LaparoscopicHernia repair: a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2015;25(5):375–83.CrossRefPubMed
4.
Bilsel Y, Abci I. The search for ideal hernia repair; mesh materials and types. Int J Surg. 2012;10(6):317–21.CrossRefPubMed
5.
Heikkinen T, Wollert S, Osterberg J, Bringman S. Early results of a randomised trial comparing Prolene and VyproII-mesh in endoscopic extraperitoneal inguinal hernia repair (TEP) of recurrent unilateral hernias. Hernia. 2006;10(1):34–40.CrossRefPubMed
6.
Robinson TN, Clarke JH, Schoen J, Walsh MD. Major mesh-related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc. 2005;19(12):1556–60.CrossRefPubMed
7.
Köckerling F, Bittner R, Jacob DA, Seidelmann L, Keller T, Adolf D, Kraft B, Kuthe A. TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endosc. 2015;29(12):3750–60.CrossRefPubMedPubMedCentral
8.
Protasov AV, Krivtsov GA, Mikhaleva LM, Tabuĭka AV, Shukhtin NI. Effects of inguinal hernioplasty mesh implant on reproductive function. Khirurgiia (Mosk). 2010;8:28–32.
9.
Shin D, Lipshultz LI, Goldstein M, Barmé GA, Fuchs EF, Nagler HM, McCallum SW, Niederberger CS, Schoor RA, Brugh VM 3rd, Honig SC. Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg. 2005;241(4):553–8.CrossRefPubMedPubMedCentral
10.
Peeters E, Spiessens C, Oyen R, De Wever L, Vanderschueren D, Penninckx F, Miserez M. Laparoscopic inguinal hernia repair in men with lightweight meshes may significantly impair sperm motility: a randomized controlled trial. Ann Surg. 2010;252(2):240–6.CrossRefPubMed
11.
Tekatli H, Schouten N, van Dalen T, Burgmans I, Smakman N. Mechanism, assessment, and incidence of male infertility after inguinal hernia surgery: a review of the preclinical and clinical literature. Am J Surg. 2012;204(4):503–9.CrossRefPubMed
12.
Kordzadeh A, Liu MO, Jayanthi NV. Male infertility following inguinal hernia repair: a systematic review and pooled analysis. Hernia. 2017;21(1):1–7.CrossRefPubMed
13.
Bansal VK, Krishna A, Manek P, Kumar S, Prajapati O, Subramaniam R, Kumar A, Kumar A, Sagar R, Misra MC. A prospective randomized comparison of testicular functions, sexual functions and quality of life following laparoscopic totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) inguinal hernia repairs. Surg Endosc. 2017;31(3):1478–86.CrossRefPubMed
14.
Krnić D, Družijanić N, Štula I, Čapkun V, Krnić D. Incarcerated inguinal hernia mesh repair: effect on testicular blood flow and sperm autoimmunity. Med Sci Monit. 2016;22:1524–33.CrossRefPubMedPubMedCentral
15.
Lal P, Bansal B, Sharma R, Pradhan G. Laparoscopic TEP repair of inguinal hernia does not alter testicular perfusion. Hernia. 2016;20(3):429–34.CrossRefPubMed
16.
Gvenetadze T. Prevention of male infertility development after Lichtenstein method. Hernia. 2016;20(1 SUPPL.1):S72.
17.
Shkvarkovskiy IV, Moskaliuk OP, Grebeniuk VI, Yakobchuk SA, Rusak OB. Clinical use of a new method of inguinal hernia repair. Georgian Med News. 2015;239:7–10.
18.
Yan L, Zhang P, Lu Z, Luo B, Xu P. Characteristics analysis and procedure selection of inguinal hernia in young male: a report of 142 cases. Chinese J Hernia Abdominal Wall Surgery (Electronic Version). 2015;9(6):23–4.
19.
Khodari M, Ouzzane A, Marcelli F, Yakoubi R, Mitchell V, Zerbib P, Rigot JM. Azoospermia and a history of inguinal hernia repair in adult. Prog Urol. 2015;25(12):692–7.CrossRefPubMed
20.
Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated march 2011]. The Cochrane collaboration. 2011. Available from www.​handbook.​cochrane.​org.
21.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials. 1996;17:1–12.CrossRefPubMed
22.
23.
Thabane L, Mbuagbaw L, Zhang S, Samaan Z, Marcucci M, Ye C, Thabane M, Giangregorio L, Dennis B, Kosa D, Borg Debono V, Dillenburg R, Fruci V, Bawor M, Lee J, Wells G, Goldsmith CH. A tutorial on sensitivity analyses in clinical trials: the what, why, when and how. BMC Med Res Methodol. 2013;13:92.CrossRefPubMedPubMedCentral
24.
Bowden J, Tierney JF, Copas AJ, Burdett S. Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC Med Res Methodol. 2011;11:41.CrossRefPubMedPubMedCentral
25.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.CrossRefPubMed
26.
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. British Med J. 1997;315(7109):629–34.CrossRef
27.
Štula I, Družijanić N, Sapunar A, Perko Z, Bošnjak N, Kraljević D. Antisperm antibodies and testicular blood flow after inguinal hernia mesh repair. Surg Endosc. 2014;28(12):3413–20.CrossRefPubMed
28.
Peeters E, Spiessens C, Oyen R, De Wever L, Vanderschueren D, Penninckx F, Miserez M. Sperm motility after laparoscopic inguinal hernia repair with lightweight meshes: 3-year follow-up of a randomised clinical trial. Hernia. 2014;18(3):361–7.PubMed
29.
Schouten N, van Dalen T, Smakman N, Elias SG, van de Water C, Spermon RJ, Mulder LS, Burgmans IP. Male infertility after endoscopic totally Extraperitoneal (Tep) hernia repair (main): rationale and design of a prospective observational cohort study. BMC Surg. 2012;12:7.CrossRefPubMedPubMedCentral
30.
Stula I, Družijanić N, Sršen D, Capkun V, Perko Z, Sapunar A, Kraljević D, Bošnjak N, Pogorelić Z. Influence of inguinal hernia mesh repair on testicular flow and sperm autoimmunity. Hernia. 2012;16(4):417–24.CrossRefPubMed
31.
Singh AN, Bansal VK, Misra MC, Kumar S, Rajeshwari S, Kumar A, Sagar R, Kumar A. Testicular functions, chronic groin pain,and quality of life after laparoscopic and open meshrepair of inguinal hernia: a prospective randomized controlled trial. Surg Endosc. 2012;26(5):1304–17.CrossRefPubMed
32.
Hallén M, Westerdahl J, Nordin P, Gunnarsson U, Sandblom G. Mesh hernia repair and male infertility: a retrospective register study. Surgery. 2012;151(1):94–8.CrossRefPubMed
33.
Skawran S, Weyhe D, Schmitz B, Belyaev O, Bauer KH. Bilateral endoscopic total extraperitoneal (TEP) inguinal hernia repair does not induce obstructive azoospermia: data of a retrospective and prospective trial. World J Surg. 2011;35(7):1643–8.CrossRefPubMed
34.
Hallén M, Sandblom G, Nordin P, Gunnarsson U, Kvist U, Westerdahl J. Male infertility after mesh hernia repair: a prospective study. Surgery. 2011;149(2):179–84.CrossRefPubMed
35.
Sucullu I, Filiz AI, Sen B, Ozdemir Y, Yucel E, Sinan H, Sen H, Dandin O, Kurt Y, Gulec B, Ozyurt M. The effects of inguinal hernia repair on testicular function in young adults: a prospective randomized study. Hernia. 2010;14(2):165–9.CrossRefPubMed
36.
Kiladze M, Gvenetadze T, Giorgobiani G. Modified Lichtenshtein hernioplasty prevents male infertility. Ann Ital Chir. 2009;80(4):305–9.PubMed
37.
Chu L, Averch TD, Jackman SV. Testicular infarction as a sequela of inguinal hernia repair. Can J Urol. 2009;16(6):4953–4.PubMed
38.
Ramadan SU, Gokharman D, Tuncbilek I, Ozer H, Kosar P, Kacar M, Temel S, Kosar U. Does the presence of a mesh have an effect on the testicular blood flow after surgical repair of indirect inguinal hernia? J Clin Ultrasound. 2009;37(2):78–81.CrossRefPubMed
39.
Yamaguchi K, Ishikawa T, Nakano Y, Kondo Y, Shiotani M, Fujisawa M. Rapidly progressing, late-onset obstructive azoospermia linked to herniorrhaphy with mesh. Fertil Steril. 2008;90(5):2018e5–7.CrossRef
40.
Brisinda G, Cina A, Nigro C, Cadeddu F, Brandara F, Marniga G, Vanella S, Bonomo L, Civello IM. Duplex ultrasound evaluation of testicular perfusion after tension-free inguinal hernia repair: results of a prospective study. Hepato-Gastroenterology. 2008;55(84):974–8.PubMed
41.
Dohle CR, Smit M, Van Den Berg M. Infertility after herniorrhaphy. Nederlands Tijdschrift voor Urologie. 2006;14(8):240–2. +229
42.
Langenbach MR, Schmidt J, Zirngibl H. Comparison of biomaterials: three meshes and TAPP for inguinal hernia. Surg Endosc. 2006;20(10):1511–7.CrossRefPubMed
43.
Nagler HM, Belletete BA, Gerber E, Dinlenc CZ. Laparoscopic retrieval of retroperitoneal vas deferens in vasovasostomy for postinguinal herniorrhaphy obstructive azoospermia. Fertil Steril. 2005;83(6):1842.CrossRefPubMed
44.
Akbulut G, Serteser M, Yücel A, Değirmenci B, Yilmaz S, Polat C, San O, Dilek ON. Can laparoscopic hernia repair alter function and volume of testis? Randomized clinical trial. Surg Laparosc Endosc Percutan Tech. 2003;13(6):377–81.CrossRefPubMed
45.
Aydede H, Erhan Y, Sakarya A, Kara E, Ilkgül O, Can M. Effect of mesh and its localisation on testicular flow and spermatogenesis in patients with groin hernia. Acta Chir Belg. 2003;103(6):607–10.CrossRefPubMed
46.
Yang KX, Ji YB, Yu WL. Three cases of infertility after inguinal hernia surgery. J Pract J. 1997;1:56–7.
47.
Junge K, Binnebösel M, Rosch R, Ottinger A, Stumpf M, Mühlenbruch G, Schumpelick V, Klinge U. Influence of mesh materials on the integrity of the vas deferens following Lichtenstein hernioplasty: an experimental model. Hernia. 2008;12(6):621–6.CrossRefPubMed
48.
Uzzo RG, Lemack GE, Morrissey KP, Goldstein M. The effects of mesh bioprosthesis on the spermatic cord structures: a preliminary report in a canine model. J Urol. 1999;161(4):1344–9.CrossRefPubMed
Metadata
Title
Does the use of hernia mesh in surgical inguinal hernia repairs cause male infertility? A systematic review and descriptive analysis
Authors
Zhiyong Dong
Stacy Ann Kujawa
Cunchuan Wang
Hong Zhao
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2018
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-018-0510-y

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