Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
Ann Surg. 2010 Aug;252(2):240-6. doi: 10.1097/SLA.0b013e3181e8fac5.
To compare quality of life and fertility aspects after laparoscopic inguinal hernia repair in men using a heavyweight or lightweight mesh.
The use of lightweight meshes in laparoscopic inguinal hernia repair could have beneficial effects on quality of life and preservation of the spermatic structures due to a decreased foreign-body reaction.
A total of 59 male patients planned for primary, unilateral or bilateral inguinal hernia repair were randomized between a standard polypropylene (Marlex) or lightweight mesh (Vypro II, TiMesh). Main outcome measures were fertility aspects, assessed preoperatively and at 1-year follow-up by semen analysis and scrotal ultrasonography. Secondary outcomes were quality of life (SF-36 and McGill Pain Questionnaire) and recurrence up to 1 year postoperatively.
Patients operated on with a VyproII or TiMesh mesh exhibited a decreased sperm motility (vs. preoperatively) compared with Marlex patients, respectively -9.5% and -5.5% versus +2% (P = 0.013). When the results after uni- and bilateral hernia repair were analyzed separately, this difference only remained significant in the bilateral hernia subgroup: -10% for VyproII and -17% for TiMesh versus +1% for Marlex (P = 0.037). Other fertility parameters (sperm concentration, morphology, and alpha-glucosidase level) were unchanged. There were no differences at any study point between the 3 groups regarding quality of life. Only for resumption of sport activities was a small advantage noted for VyproII versus Marlex patients (P = 0.045). After 1 year, no recurrences were observed; 3 patients (6%) complained of chronic disabling pain.
Our data suggest that the use of lightweight meshes for laparoscopic inguinal hernia repair in male patients negatively influences sperm motility, without any benefit on quality of life. These alterations might be important in a subgroup of young male patients operated on laparoscopically for a bilateral hernia. This study was registered in the clinicaltrials.gov database (ID number NCT00925067).
比较使用重质网片与轻质网片行腹腔镜腹股沟疝修补术对男性患者生活质量和生育方面的影响。
腹腔镜腹股沟疝修补术中使用轻质网片可通过减少异物反应，对生活质量和精索结构的保留产生有益影响。
共 59 例男性患者拟行单侧或双侧腹股沟疝择期修补术，随机分为标准聚丙烯（Marlex）组或轻质网片（Vypro II、TiMesh）组。主要观察指标为生育方面，术前和术后 1 年通过精液分析和阴囊超声检查评估。次要观察指标为生活质量（SF-36 和 McGill 疼痛问卷）和术后 1 年内的复发率。
与 Marlex 组患者相比，行 Vypro II 或 TiMesh 网片修补术的患者精子活动力分别降低了-9.5%和-5.5%，而 Marlex 组患者则增加了 2%（P = 0.013）。当分别分析单侧和双侧疝修补术后的结果时，这种差异仅在双侧疝亚组中仍然显著：Vypro II 为-10%，TiMesh 为-17%，而 Marlex 为 1%（P = 0.037）。其他生育参数（精子浓度、形态和α-葡萄糖苷酶水平）无变化。在任何研究时间点，3 组患者的生活质量均无差异。仅在恢复运动活动方面，Vypro II 组患者略优于 Marlex 组（P = 0.045）。术后 1 年无复发，3 例（6%）患者出现慢性致残性疼痛。
我们的数据表明，在男性患者中行腹腔镜腹股沟疝修补术使用轻质网片会降低精子活动力，而对生活质量无任何益处。这些改变在因双侧疝行腹腔镜手术的年轻男性亚组中可能很重要。本研究已在临床试验.gov 数据库中注册（注册号 NCT00925067）。
