Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial
- 674 Downloads
Laparoscopic inguinal hernia repair is still not the gold standard for patients with inguinal hernia. The aim of this study was to compare testicular dysfunction, incidence and factors influencing chronic groin pain, and quality of life after laparoscopic and open mesh repair.
One hundred twenty patients were studied in a prospective randomized trial. One hundred seventeen patients completed the required follow-up, 60 following laparoscopic repair and 57 following open repair. Testicular functions were assessed by testicular volume, blood flow, and hormones, and quality of life was assessed with Short Form 36 version 2 preoperatively and postoperatively at 3 months. Pain was assessed at different time intervals preoperatively and postoperatively.
Preoperative profiles of both groups were well matched. A significant decrease in testicular volume (p = 0.01) and less improvement in blood flow (p = 0.048) was seen after open repair. There was also a significant reduction in serum testosterone level (p = 0.02) with a significant increase in FSH and LH level (p < 0.001); however, there was no testicular atrophy. Incidence and severity of chronic groin pain were significantly less after laparoscopic repair during normal and strenuous activities, though they were similar to those after open repair during rest after 3 months postoperatively. Age, preoperative pain, pain at 1 week, and open repair were found to be independent risk factors for chronic pain on multivariate analysis. Quality of life was significantly better postoperatively in terms of physical functions, role physical, bodily pain, and general health after laparoscopic repair.
Laparoscopic repair seems favorable in terms of better preservation of testicular functions, lower incidence of acute and chronic groin pain, and significant improvement in quality of life when compared to open repair. Younger age, preoperative pain, pain after 1 week postoperatively, and open mesh repair were found to be significant risk factors for chronic groin pain.
KeywordsLaparoscopic inguinal hernia repair Open mesh repair Testicular dysfunctions Chronic groin pain Quality of life
Drs. Anand Narayan Singh, Virinder Kumar Bansal, M. C. Misra, Subodh Kumar, S. Rajeshwari, Atin Kumar, Rajesh Sagar, and Anand Kumar have no conflicts of interest or financial ties to disclose.
- 1.Devlin HB (1995) Trends in hernia surgery in the land of Astley Cooper. In: Soper NJ (ed) Problems in general surgery, vol 12. Lippincott Raven, Philadelphia, pp 85–92Google Scholar
- 4.McCormack K, Scott NW, Go PM, Ross S, Grant AM, EU Hernia Trialists Collaboration (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785Google Scholar
- 11.Korolija D, Sauerland S, Wood-Dauphinee S, Abbou CC, Eypasch E, Caballero MG, Lumsden MA, Millat S, Monson JR, Nilsson G, Pointner R, Schwenk W, Shamiyeh A, Szold A, Targarona E, Ure B, Neugebauer E (2004) Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 18:879–897PubMedCrossRefGoogle Scholar
- 15.Nyhus LM (1993) Individualization of hernia repair: a new era. Surgery 114:102Google Scholar
- 16.Kulaylat MN, Dayton MT (2008) Surgical Complications. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL (eds) Sabiston Textbook of Surgery. Saunders, Philadelphia, p 331Google Scholar
- 18.International Association for the Study of Pain Subcommittee on Taxonomy (1986) Classification of chronic pain: Description of chronic pain syndromes and definition of pain terms. Pain 3:S1-S226Google Scholar
- 20.Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, Juul P, Callesen T, Danish Hernia Database Collaboration (2001) Quality assessment of 26304 herniorrhaphies in Denmark: a prospective study. Lancet 358:1124–1128Google Scholar
- 29.Celik AS, Memmi N, Celebi F, Guzey D, Celik A, Kaplan R, Oncu M (2009) Impact of slit and nonslit mesh technique on testicular perfusion and volume in the early and late postoperative period of the totally extraperitoneal preperitoneal technique in patients with inguinal hernia. Am J Surg 2:287–291CrossRefGoogle Scholar
- 32.Neumayer L, Hurdcr AG, Jonasson O, Fitzgibbons R, Dunlop D., Gibbs J, Reda D, Henderson W; Veterans Affairs Cooperative Studies Program 456 Investigators (2004) Open mesh vs laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819-1827Google Scholar
- 39.Liem MS, van Duyn EB, van der Graaf Y, van Vroonhoven TJ; Coala Trial Group (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 237:136–141Google Scholar