Title: Effect of Prosthetic Mesh in Laparoscopic Hernia Repair and Lichtenstein Procedure on Testicular Blood Flow in Patients with Inguinal Hernia

Authors: Jitendra B Bhadoria, Nimish Shah

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i9.21

Abstract

Background: As there are fewer studies on the effect of mesh on testicular function, our study intends to review the safety profile of the Lichtenstein inguinal hernia repair and laparoscopic hernia repair with polypropylene mesh on male gonadal function in terms of testicular perfusion.

Aim and Objectives: To determine whether hernioplasty (open & laparoscopic) using synthetic mesh has influence on testicular perfusion.

Methods: Data was collected from the department of surgery at SSGH in the period from January 2015 to August 2015. The patients were studied by Doppler flow parameter PSV, EDV, PI, RI pre operatively, in the early post operative period (post operative 3rd day) and late post operative period (post operative 6th month).

Results: Total 70 patients were studied. 52 patients were operated by Lichtenstein procedure and 18 by Lap-TEP hernia repair with placement of prosthetic mesh. Doppler study was done postoperatively on 3rd day and on 6th month. Data were collected analysed for both group seperately, testicular perfusion and flow was analysed using Student Newman Kuels test to analyse within  the subgroups and it showed us that there is a statistical significant difference between pre – operative and post – operative 3rd day parameter , post-operative 3rd day and post-operative 6th month parameter. There is no statistical difference between pre-operative parameters and post-operative 6th month parameter. This result was seen in both group Lichtenstein as well as Lap-TEP repair.

Conclusion: No alteration in testicular volume and arterial flow after a six-month period was observed among patients who underwent surgical correction for inguinal hernia  using a polypropylene prosthesis.

Keywords: Inguinal hernia, Scrotal Doppler, Lichtenstein, Lap-TEP.

References

1.      Dilek: Hernioplasty and testicular perfusion Springer Plus 2014 3:107.

2.      Bailey M. The case for laparoscopic repair. Ann R Collsurg Eng 12005;87-57-58

3.      Coob WS, Kercher KW, Heniford T. The argument for lightweight polypropilene mesh in hernia repair. Surg Inn. 2005;12(1):20-7.

4.      Klosterhalfen B, Junge K, Klinge U. The lightweight and large porus mesh concept for hernia repair. Exp Rev Med Dev. 2005;2(1):1-15.

5.      Shulman AG, Amid PK, Lichtenstein IL. A survey of non-expert surgeons using the open tension-free mesh patch repair for primary inguinal hernias. Int Surg. 1995;80:35-6.

6.      Zieren J, Beyersdorff D, Beier KM, Müller JM. Sexual function and testicular perfusion after inguinal hernia repair with mesh. Am J Surg. 2001;181:204-6.

7.      Amid PK. Lichtenstein tension-free hernioplasty: its inception, evolution and principles. Hernia. 2004;8(1):1-7.

8.      Wantz GE. Testicular atrophy as a risk of inguinal hernioplasty. Surg Gynecol Obstet. 1982;154:570-1.

9.      Amid PK, Lichtenstein IL. Long-term result and current status of the Lichtenstein open tension-free hernioplasty. Hernia. 1998;89(2):89-94.

10.  Amid PK, Friis E, Horeyseck, Kux M. A multi-center experience with 6,764 Lichtenstein tension-free herniplasties. Hernia. 1999; 3:47-8

11.  Shin D1, Lipshultz LI, Goldstein M, Barmé GA, Fuchs EF, Nagler HM, McCallum SW, Niederberger CS, Schoor RA, Brugh VM 3rd & Honig SC (2005). Herniorrhaphy with polypropylene mesh causing vassal obstruction: a preventable cause of obstructive azoospermia. Annals of Surgery, 241(4) 553-558

12.  Bakırköy Tıp Dergisi, Cilt 6, Sayı 1, 2010 / Medical Journal of Bakırköy, Volume 6, Number 1, 2010

13.  Ind. J. Sci. Res. and Tech. 2015 3(4):66-71/Kumar et al ISSN:-2321-9262

14.  Lima Neto EV, Goldenberg A, Jucá MJ. Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia. Acta Cir Bras. [serial on the Internet] 2007 July-Aug 22(4).

15.  H. Aydede*, Y. Erhan*, A. Sakarya*, E. Kara**, Ö. I.lkgül**, M. Can***Effect of Mesh and its Localisation on Testicular Flow and Spermatogenesis in Patients with Groin Hernia Acta chir belg, 2003, 103, 607-610

16.  Amid PK, Shulman AG, Lichtenstein IL. Acritical comparision of laparoscopic hernia repair with Lichtenstein tension free hernioplasty. Med J Australia 1994;161: 239-40

17.  Polglase AL, McMurrick. The cut or the key hole? Laparoscopic or open hernia repair of inguinal hernia? Med J Australia 1994;161:238-239

18.  Arregui ME, Navarrete J, Davis CJ et al. Laparoscopic inguinal herniorrhaphy. Results of a multicenter Trial. Ann Surg 1995;73(3):513-527

19.  Kavis MS. Laparoscopic hernia repair. Surg Endosc 1993;7:163-167

20.  Cornell PB, Kerlakian GM. Early complications and outcomes of the current technique of transperitoneal open approach. Am J Surg 1994;168: 275-279

21.  Horton MD, Florence MG. Simplified properitoneal marlex hernia repair. Am J Surg 1993;165:595-59

22.  Zieren J, Zieren HU, Wenger FA et al. Laparoscopic or conventional repair of inguinal hernia with synthetic mesh? Langenbacks Arch Chir 1996;381:289-294

23.  Amid PK, Shulman AG, Lichtenstein IL, Hakhakha M. The goals of modern surgery. How to achieve them. Prob Gen Surg, 12:165-171 

Corresponding Author

Jitendra B. Bhadoria

Address: 44, Durganagar So, B/h Takshashila School

Vastral, Ahmedabad-382418.

Email:  This email address is being protected from spambots. You need JavaScript enabled to view it., Contact no.: 9925061300