Department of Visceral and Trauma Surgery, Knappschaftskrankenhaus, Wieckesweg 27, 44309, Dortmund, Germany.
World J Surg. 2011 Jul;35(7):1643-8. doi: 10.1007/s00268-011-1072-0.
The endoscopic totally extraperitoneal (TEP) mesh repair is nowadays a well-established tension-free method for inguinal hernia repair. Mainly based on animal studies and case reports, a concern about the risk of postoperative infertility was expressed. This clinical study aimed to evaluate the risk of infertility due to obstructive azoospermia in men of fertile age who underwent a bilateral hernia repair.
Over 3 years (2005-2008) 59 male patients, 18-60 years of age, underwent a bilateral TEP repair. Twenty-one of them were prospectively ("light mesh") and 38 retrospectively ("heavy mesh") evaluated for testicular volume and perfusion, serum levels of sexual hormones, ejaculate volume, and number of spermatic cells. Those parameters were determined preoperatively (prospective group) and not earlier than 3 months postoperatively (both groups).
No significant difference between pre- and postoperative values was detected in the prospectively studied group. All postoperative parameters were within the normal range in the retrospective group. There was no evidence of impaired fertility in any patient due to the operation.
The standardized TEP technique for simultaneous bilateral inguinal hernia repair in male patients was not associated with a higher risk for postoperative infertility after mesh implantation. The use of heavy-weight meshes had no negative effect on fertility.
如今，内镜完全腹膜外（TEP）网片修补术已成为一种成熟的无张力腹股沟疝修补方法。主要基于动物研究和病例报告，人们对术后不育的风险表示担忧。本临床研究旨在评估行双侧疝修补术的适龄生育男性发生梗阻性无精子症导致不育的风险。
3 年多（2005-2008 年），59 名 18-60 岁的男性患者接受了双侧 TEP 修复。其中 21 名患者前瞻性地（“轻网片”），38 名患者回顾性地（“重网片”）评估睾丸体积和灌注、血清性激素水平、精液量和精子数量。这些参数在术前（前瞻性组）和术后至少 3 个月（两组）进行测定。
前瞻性研究组术前与术后值无显著差异。回顾性组所有术后参数均在正常范围内。手术没有导致任何患者的生育能力受损。
对于男性患者，行双侧腹股沟疝同时修补的标准化 TEP 技术在植入网片后，并不会增加术后不育的风险。使用重网片对生育能力没有负面影响。
