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Male infertility following inguinal hernia repair: a systematic review and pooled analysis

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Abstract

Introduction

The aim of this systematic review is to establish the clinical impact of open (mesh and/or without mesh) and laparoscopic hernia repair (transabdominal pre-peritoneal (TAP) and/or totally extra-peritoneal (TEP)) on male fertility. The incidence of male infertility following various types of inguinal hernia repair is currently unknown. The lack of high-quality evidence has led to various speculations, suggestions and reliance on anecdotal experience in the clinical practice.

Methods

An electronic search of the literature in Medline, Scopus, Embase and Cochrane library from 1966 to October 2015 according to PRISMA checklist was conducted. Quality assessment of articles was conducted using the Oxford Critical Appraisal Skills Programme (CASP) and their recommendation for practice was examined through National Institute for Health and Care Excellence (NICE). This resulted in ten studies (n = 10), comprising 35,740 patients.

Results

Sperm motility could be affected following any type and/or technique of inguinal hernia repair but this is limited to the immediate postoperative period (≤48 h). Obstructive azoospermia was noted in 0.03% of open and 2.5% of bilateral laparoscopic (TAP) hernia repair with mesh. Male infertility was detected in 0.8% of the open hernia repair (mesh) with no correlation to the type of mesh (lightweight vs. heavyweight).

Conclusion

Inguinal hernia repair without mesh has no impact on male fertility and obstructive azoospermia. However, the use of mesh in bilateral open and/or laparoscopic repair may require the inclusion of male infertility as the part of informed consent in individuals that have not completed their family or currently under investigations.

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References

  1. Jenkins JT, O’Dwyer PJ (2008) Inguinal hernias. BMJ 336(7638):269–272

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wantz EG (1984) Complications of inguinal hernia repair. Surg Clin North Am 64(2):287–298

    Article  CAS  PubMed  Google Scholar 

  3. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) (2009) The World Health Organization (WHO) Revised Glossary on ART Terminology

  4. Moher D, Liberati A, Tetzlaff J et al (2009) PRISMA group preferred reporting items for systematic reviews and meta analysis: the PRISMA statement. J clin Epidemol 62(10):1006–1012

    Article  Google Scholar 

  5. CASP critical Appraisal Skills Programme OXFORD UK found at: http://media.wix.com/ugd/dded87_e37a4ab637fe46a0869f9f977dacf134.pdf

  6. Weightman A, Ellis I, Cullum A et al. (2006) Grading evidence and recommendation for public health interventions: developing ad piloting a framework. http://www.nice.org.uk/guidance/ph1/resources/methodsfor-development-of-nice-public-health-guidance2

  7. Schafer M (2011) Bilateral endoscopic total extraperitoneal (TEP) inguinal hernia repair does not induce obstructive azoospermia: data of a retrospective and prospective trial. World J Surg 35:1649–1650

    Article  PubMed  Google Scholar 

  8. Brendsen FH, Bjursten LM, Simanaitis M et al (2004) Does mesh implantation affect the spermatic cord structure after inguinal hernia surgery? Eur Surg Res 36:318–322

    Article  Google Scholar 

  9. Uzzo RG, Lemack GE, Morrissey KP et al (1999) The effect of mesh bioprosthesis on the spermatic cord structures: a preliminary report in canine model. J Urol 161:1344–1349

    Article  CAS  PubMed  Google Scholar 

  10. Shah NR, Mikami DJ, Cook C et al. (2011) A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias. Surg Endosc 25(7):2330–2337

    Article  PubMed  Google Scholar 

  11. Perko Z, Rakic M, Pogorelic Z et al (2011) Laparoscopic trans abdominal preperitoneal approach for inguinal hernia repair: a five year experience at a single center. Surg Today 41:216–221

    Article  PubMed  Google Scholar 

  12. Stula I, Druzijanic N, Srsen D, Capkun V, Perko Z, Sapunar A et al (2012) Influence of inguinal hernia mesh repair on testicular flow and sperm autoimmunity. Hernia 16(4):417–424

    Article  CAS  PubMed  Google Scholar 

  13. Yavetz H, Harash B, Yogev L, Homonnai ZT, Paz G (1991) Fertility of men following inguinal hernia repair. Andrologia 23(6):443–446

  14. Aydede H, Erhan Y, Sakarya A, Kara E, Ilkgul O, Can M (2003) Effect of mesh and its localisation on testicular flow and spermatogenesis in patients with groin hernia. Acta Chir Belg 103(6):607–610

  15. Peeters E, Spiessens C, Oyen R, De Wever L, Vandeschueren D, Penninckx F et al (2014) Sperm motility after laparoscopic inguinal hernia with lightweight meshes: 3 year follow up of a randomised clinical trial. Hernia 18:361–367

    Article  CAS  PubMed  Google Scholar 

  16. Shin D, Lipshultz LI, Goldstein M, Barme GA, Fuchs EF, Nagler HM et al (2005) Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg 241(4):553–558

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kiladze M, Gvenetadze T, Giorgobiani G (2009) Modified Lichtenshtein hernioplasty prevents male infertility. Ann Ital Chir 80(4):305–309

  18. Skawran S, Weyhe D, Schmitz B, Belyaev O, Bauer KH (2011) Bilateral endoscopic total extraperitoneal (TEP) inguinal hernia repair does not induce obstructive azoospermia: data of a retrospective and prospective trial. World J Surg 35(7):1643–1648

    Article  CAS  PubMed  Google Scholar 

  19. Hallen M, Sandblom G, Nordin P, Gunnarsson U, Kvist U, Westerdahl J (2011) Male infertility after mesh hernia repair: a prospective study. Surgery 149(2):179–184

    Article  PubMed  Google Scholar 

  20. Hallen M, Westerdahl J, Nordin P, Gunnarsson U, Sandblom G (2012) Mesh hernia repair and male infertility: a retrospective register study. Surgery 151(1):94–98

    Article  PubMed  Google Scholar 

  21. Stula I, Druzijanic N, Sapunar A, Perko Z, Bosnjak N, Kraljevic D (2014) Antisperm antibodies and testicular blood flow after inguinal hernia mesh repair. Surg Endosc 28(12):3413–3420

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Chelmsford, CM1 7ET, UK

    A. Kordzadeh, M. O. Liu & N. V. Jayanthi

Authors
  1. A. Kordzadeh
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  2. M. O. Liu
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  3. N. V. Jayanthi
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Corresponding author

Correspondence to A. Kordzadeh.

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AK declares no conflict of interest. ML declares no conflict of interest. NVR declares no conflict of interest.

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Kordzadeh, A., Liu, M.O. & Jayanthi, N.V. Male infertility following inguinal hernia repair: a systematic review and pooled analysis. Hernia 21, 1–7 (2017). https://doi.org/10.1007/s10029-016-1560-0

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