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Bilateral endoscopic totally extraperitoneal (TEP) inguinal hernia repair does not impair male fertility

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Abstract

Purpose

Endoscopic totally extraperitoneal (TEP) hernia repair with polypropylene mesh has become a well-established technique. However, since the mesh is placed in close contact with the spermatic cord, mesh-induced inflammation may affect its structures, possibly resulting in impaired fertility. The aim of this observational prospective cohort study was to assess fertility after bilateral endoscopic TEP inguinal hernia repair in male patients.

Methods

Fifty-seven male patients (22–60 years old) with primary, reducible, bilateral inguinal hernias underwent elective bilateral endoscopic TEP hernia repair with use of polypropylene mesh. The primary outcome was testicular perfusion; secondary outcomes were testicular volume, endocrinological status, and semen quality. All patients were assessed preoperatively and 6 months postoperatively.

Results

Follow-up was completed in 44 patients. No statistically significant differences in measurements of testicular blood flow parameters or testicular volume were found. Postoperative LH levels were significantly higher [preoperative median 4.3 IU/L (IQR 3.4–5.3) versus postoperative median 5.0 IU/L (IQR 3.6–6.5), p = 0.03]. Levels of inhibin B were significantly lower postoperatively [preoperative median 139.0 ng/L (IQR 106.5–183.0) versus postoperative median 27.0 ng/L (IQR 88.3–170.9), p = 0.01]. No significant changes in FSH or testosterone levels were observed. There were no differences in semen quality.

Conclusions

Our data suggest that bilateral endoscopic TEP hernia repair with polypropylene mesh does not impair fertility, as no differences in testicular blood flow, testicular volume, or semen quality were observed. Postoperative levels of LH and inhibin B differed significantly from preoperative measurements, yet no clinical relevance could be ascribed to these findings.

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Authors and Affiliations

  1. Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Utrecht, The Netherlands

    M. M. Roos, G. J. Clevers, E. J. Verleisdonk, P. H. Davids & J. P. J. Burgmans

  2. Department of Clinical Chemistry, Diakonessenhuis Utrecht/Zeist, Utrecht, The Netherlands

    C. van de Water

  3. Department of Urology, Diakonessenhuis Utrecht/Zeist, Utrecht, The Netherlands

    R. J. Spermon

  4. Department of Radiology, Diakonessenhuis Utrecht/Zeist, Utrecht, The Netherlands

    L. S. Mulder

Authors
  1. M. M. Roos
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  2. G. J. Clevers
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  3. E. J. Verleisdonk
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  4. P. H. Davids
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  5. C. van de Water
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  6. R. J. Spermon
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  7. L. S. Mulder
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  8. J. P. J. Burgmans
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Contributions

MR: data collection, analysis and interpretation of data, drafting of manuscript. GJC: study conception and design, critical revision, EJV: study conception and design, critical revision. PD: study conception and design, critical revision. CW: study conception and design (clinical chemistry), interpretation of data (clinical chemistry), critical revision. RS: study conception and design (urology), interpretation of data (urology), critical revision. LSM: study conception and design (radiology), interpretation of data (radiology), critical revision. IB: study conception and design, drafting of manuscript, critical revision.

Corresponding author

Correspondence to M. M. Roos.

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The authors declare that they have no conflict of interests.

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Ethical approval was obtained by the Regional Medical Ethics Committee and the hospitals EthicsBoard.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Cite this article

Roos, M.M., Clevers, G.J., Verleisdonk, E.J. et al. Bilateral endoscopic totally extraperitoneal (TEP) inguinal hernia repair does not impair male fertility. Hernia 21, 887–894 (2017). https://doi.org/10.1007/s10029-017-1657-0

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  • DOI: https://doi.org/10.1007/s10029-017-1657-0

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