Abstract
The implantation of a non-absorbable polypropylene mesh during hernia repair causes chronic foreign body reaction involving the surrounding tissue. In case of inguinal hernia repair using mesh techniques, the spermatic cord is potentially affected by this chronic inflammatory tissue remodeling. This effect has been investigated using standardized animal models (pig and rabbit). Fifteen adult male pigs underwent transinguinal preperitoneal implantation of a polypropylene mesh. The contralateral side with a Shouldice repair served as control. After 7, 14, 21, 28, and 35 days, three animals were sacrificed. The spermatic cords were resected and analyzed histologically. In a second experiment Lichtenstein repair using the same polypropylene mesh and Shouldice repair on the contralateral side was done in eight chinchilla rabbits. Three animals served as controls. Three months after operation, the analysis included testicular size, testicular temperature, and testicular and spermatic cord perfusion. We added histological evaluation of the foreign body reaction and the spermatogenesis using the Johnsen score. In the pig, we observed a certain foreign body reaction with diffuse infiltrating inflammatory cells after mesh implantation. Venous thrombosis of the spermatic veins occurred in five of 15 cases. One animal presented focal fibrinoid necrosis of the deferent duct wall. The side of Shouldice repair showed only minor postoperative changes. In the rabbit, we also observed a typical foreign body reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. The mesh repair led to a decrease of arterial perfusion, testicular temperature, and the rate of seminiferus tubules with regular spermatogenesis classified as Johnsen 10 (Lichtenstein: 48.1%, Shouldice: 63.8%, controls: 65.8%). Testicular volume increased about 10% after each operation. The implantation of a polypropylene mesh in the inguinal region induces major response of the structures of the spermatic cord. This may have an influence also on spermatogenesis. Due to this a strict indication for implantation of a prosthetic mesh during inguinal hernia repair is recommended.
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References
Bittner R, Schmedt CG, Schwarz J, Kraft K, Leibl BJ (2002) Laparoscopic transperitoneal procedure for routine repair of groin hernia. Br J Surg 89:1062–1066
Wara P, Bay-nielsen M, Juul P, Bendix J, Kehlet H (2005) Prospective nationwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia. Br J Surg 92:1277–1281
Fenoglio ME, Bermas HR, Haun WE, Moore JT (2005) Inguinal hernia repair: results using an open preperitoneal approach. Hernia 9:160–161
Klosterhalfen B, Klinge U, Hermanns B, Schumpelick V (2000) Pathology of traditional surgical nets for hernia repair after long-term implantation in humans. Chirurg 71:43–51
Silich RC, McSherry CK (1996) Spermatic granuloma. An uncommon complication of the tension-free repair. Surg Endosc 10:537–539
Hetzer FH, Hotz T, Steinke W, Schlumpf R, Decurtins M, Largiader F (1999) Gold standard for inguinal hernia repair: Shouldice or Lichtenstein? Hernia 3:117–120
Schumpelick V, Arlt G (1996) Transinguinal preperitoneal mesh-plasty in inguinal hernia using local anesthesia. Chirurg 67:419–424
Shouldice EE (1945) Surgical treatment of hernia. Ontar Med Rev 4:43
Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193
Peiper Ch, Ponschek N, Truong S, Schumpelick V (2000) Ultrasound-based volumetric evaluation of fluid retention after inguinal hernia repair. Surg Endosc 14:666–669
Johnsen SG (1970) Testicular biopsy score count—a method for registration of spermatogenesis in human testes: normal values and results in 335 hypogonadal males. Hormones 1:2–25
Klinge U, Klosterhalfen B, Müller M, Schumpelick V (1999) Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 165:665–673
Trabucchi EE, Corsi FR, Mainardi C, Cellerino P, Allevi R, Foschi DA (1998) Tissue response to polyester mesh for hernia repair: an ultramicroscopic study in man. Hernia 2:107–112
Uzzo RG, Lemack GE, Morrissey KP, Goldstein M (1999) The effects of mesh bioprosthesis on the spermatic cord structures: a preliminary report in a canine model. J Urol 161:1344–1349
Beets GL, van Mameren H, Go PMNYH (1998) Long-term foreign-body reaction to preperitoneal polypropylene mesh in the pig. Hernia 2:153–155
Leblanc KA, Booth WV, Whitaker JM, Baker D (1998) In vivo study of meshes implanted over the inguinal ring and external iliac vessels in uncastrated pigs. Surg Endosc 12:247–251
Fitzgibbons RJ Jr, Salerno GM, Filipi CJ, Hunter WJ, Watson P (1994) A laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia. Ann Surg 219:144–156
Wingenbach O, Waleczek H, Kozianka J (2004) Laparoscopic hernioplasty by transabdominal preperitoneal approach. Analysis and review in 267 cases. Zentralbl Chir 129:369–373
Langenbach M, Schmidt J, Lazika M, Zirngibl H (2003) Urological symptoms after laparoscopic hernia repair. Reduction with a variant of polypropylene mesh. Urologe 42:375–381
Shin D, Lipshultz LI, Goldstein M, Barme GA, Fuchs EF, Nagler HM, McCallum SW, Niederberger CS, Schoor RA, Brugh VM 3rd, Honig SC (2005) Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg 241:553–558
Acknowledgements
These experiments were supported by the Deutsche Forschungsgemeinschaft (AZ KON 709/2002, PE 718/4-1)
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Peiper, C., Junge, K., Klinge, U. et al. Is there a risk of infertility after inguinal mesh repair? Experimental studies in the pig and the rabbit. Hernia 10, 7–12 (2006). https://doi.org/10.1007/s10029-005-0055-1
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DOI: https://doi.org/10.1007/s10029-005-0055-1