Peiper Christian, Junge Karsten, Klinge Uwe, Strehlau Eva, Ottinger A, Schumpelick Volker
Surgical Clinic, Evangelisches Krankenhaus, Pferdebachstr. 27, 58455, Witten, Germany.
Hernia. 2006 Mar;10(1):7-12. doi: 10.1007/s10029-005-0055-1. Epub 2005 Dec 14.
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.
疝修补术中植入不可吸收的聚丙烯网片会引发涉及周围组织的慢性异物反应。在采用网片技术进行腹股沟疝修补时,精索可能会受到这种慢性炎症组织重塑的影响。已使用标准化动物模型(猪和兔)对这种影响进行了研究。15只成年雄性猪接受了经腹股沟腹膜前聚丙烯网片植入术。对侧采用Shouldice修补术作为对照。在术后7、14、21、28和35天,处死3只动物。切除精索并进行组织学分析。在第二项实验中,对8只龙猫兔进行了使用相同聚丙烯网片的Lichtenstein修补术,并在对侧进行Shouldice修补术。3只动物作为对照。术后3个月,分析内容包括睾丸大小、睾丸温度以及睾丸和精索的灌注情况。我们还使用约翰森评分对异物反应和精子发生进行了组织学评估。在猪身上,我们观察到网片植入后出现一定程度的异物反应,伴有弥漫性浸润性炎症细胞。15例中有5例出现精索静脉血栓形成。1只动物出现输精管壁局灶性纤维蛋白样坏死。Shouldice修补术一侧仅显示轻微的术后改变。在兔身上,我们同样观察到网片与周围组织界面处有典型的异物反应,而Shouldice修补术后未检测到这种反应。网片修补导致动脉灌注、睾丸温度以及具有正常精子发生的生精小管比例降低(Lichtenstein修补术:48.1%,Shouldice修补术:63.8%,对照组:65.8%)。每次手术后睾丸体积增加约10%。在腹股沟区植入聚丙烯网片会引起精索结构的主要反应。这可能也会对精子发生产生影响。因此,建议在腹股沟疝修补术中严格掌握使用人工网片的指征。