Roos M M, Clevers G J, Verleisdonk E J, Davids P H, van de Water C, Spermon R J, Mulder L S, Burgmans J P J
Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Utrecht, The Netherlands.
Department of Clinical Chemistry, Diakonessenhuis Utrecht/Zeist, Utrecht, The Netherlands.
Hernia. 2017 Dec;21(6):887-894. doi: 10.1007/s10029-017-1657-0. Epub 2017 Aug 29.
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.
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.
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.
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.
使用聚丙烯补片进行内镜下完全腹膜外（TEP）疝修补术已成为一种成熟的技术。然而，由于补片与精索紧密接触，补片引起的炎症可能会影响其结构，进而可能导致生育能力受损。这项观察性前瞻性队列研究的目的是评估男性患者双侧内镜TEP腹股沟疝修补术后的生育能力。
57例年龄在22至60岁之间、患有原发性、可复性双侧腹股沟疝的男性患者接受了使用聚丙烯补片的择期双侧内镜TEP疝修补术。主要结局指标为睾丸灌注；次要结局指标为睾丸体积、内分泌状态和精液质量。所有患者在术前和术后6个月接受评估。
44例患者完成随访。未发现睾丸血流参数测量值或睾丸体积有统计学显著差异。术后促黄体生成素（LH）水平显著升高[术前中位数为4.3 IU/L（四分位间距3.4 - 5.3），术后中位数为5.0 IU/L（四分位间距3.6 - 6.5），p = 0.03]。术后抑制素B水平显著降低[术前中位数为139.0 ng/L（四分位间距106.5 - 183.0），术后中位数为27.0 ng/L（四分位间距88.3 - 170.9），p = 0.01]。促卵泡生成素（FSH）或睾酮水平未观察到显著变化。精液质量无差异。
我们的数据表明，使用聚丙烯补片进行双侧内镜TEP疝修补术不会损害生育能力，因为未观察到睾丸血流、睾丸体积或精液质量有差异。术后LH和抑制素B水平与术前测量值有显著差异，但这些发现尚无临床相关性。
