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Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Disclosures

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.

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Authors and Affiliations

  1. Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India

    Anand Narayan Singh, Virinder Kumar Bansal, Mahesh C. Misra & Subodh Kumar

  2. Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India

    S. Rajeshwari

  3. Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India

    Atin Kumar

  4. Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India

    Rajesh Sagar

  5. Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India

    Anand Kumar

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  1. Anand Narayan Singh
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Correspondence to Virinder Kumar Bansal.

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Singh, A.N., Bansal, V.K., Misra, M.C. et al. Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial. Surg Endosc 26, 1304–1317 (2012). https://doi.org/10.1007/s00464-011-2029-y

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