Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), 255 Dr Enéas de Carvalho Aguiar Av. Cerqueira Cesar, São Paulo, 05402-000, Brazil.
Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), São Paulo, Brazil.
Surg Endosc. 2023 Dec;37(12):9263-9274. doi: 10.1007/s00464-023-10499-8. Epub 2023 Oct 25.
The effects of hernia repair on testicular function remain uncertain, regardless of the technique used. Studies that analyze testicular volume and flow after hernia repair or hormonal measurements are scarce and show contradictory results. This study aimed to evaluate the impact of bilateral inguinal hernia repair on male fertility in surgical patients in whom the Lichtenstein and laparoscopic transabdominal preperitoneal (TAPP) techniques were used.
A randomized clinical trial comparing open (Lichtenstein) versus laparoscopic (TAPP) hernia repair using polypropylene mesh was performed in 48 adult patients (20 to 60 years old) with primary bilateral inguinal hernia. Patients were evaluated preoperatively and 90 and 180 postoperative (PO) days. Sex hormones (Testosterone, FSH, LH and SHGB) analysis, testicular ultrasonography, semen quality sexual activity changes and quality of life (QoL) were performed. Postoperative pain was evaluated using the visual analog scale (VAS).
Thirty-seven patients with aged of 44 ± 11 years were included, 19 operated on Lichtenstein and 18 operated on TAPP. The surgical time was similar between techniques. The pain was greater in the Lichtenstein group on the 7th PO day. The biochemical and hormonal analyses, testicular ultrasonography (Doppler, testicular volume, and morphological findings) and sperm quality were similar between groups. However, the sperm morphology was better in the Lichtenstein group after 180 days (p < 0.05 vs. preoperative) and two patients who underwent Lichtenstein hernia repair had oligospermia after 180 days. The QoL evaluation showed a significant improvement after surgery in the following domains: physical function, role emotional, bodily pain and general health (p < 0.05). On comparison of Lichtenstein vs. TAPP none of the domains showed statistically significant differences. No patient reported sexual changes.
Bilateral inguinal hernia repair with polypropylene mesh, whether using Lichtenstein or TAPP, does not impair male fertility in terms of long-term outcomes.
Approved by the Ethics Committee for the Analysis of Research Projects (CAPPesq) of the HC/FMUSP, Number 2.974.457, in June 2015, Registered on Plataforma Brasil in October 2015 under Protocol 45535015.4.0000.0068. Registered on Clinicaltrials.gov, NCT05799742. Enrollment of the first subject in January 2016.
无论采用何种技术，疝修补术对睾丸功能的影响仍不确定。分析疝修补术后睾丸体积和血流或激素测量的研究很少，且结果相互矛盾。本研究旨在评估在接受手术治疗的患者中，使用聚丙烯网片进行双侧腹股沟疝修补术对男性生育力的影响，这些患者采用了经腹腹膜前腹腔镜（TAPP）技术和开放式（Lichtenstein）技术。
在 48 例年龄在 20 至 60 岁的原发性双侧腹股沟疝成年患者中进行了一项比较开放式（Lichtenstein）与腹腔镜（TAPP）疝修补术的随机临床试验，采用聚丙烯网片。患者在术前、术后 90 天和 180 天进行了性激素（睾酮、FSH、LH 和 SHBG）分析、睾丸超声检查、精液质量、性活动变化和生活质量（QoL）评估。术后疼痛采用视觉模拟评分（VAS）进行评估。
37 例年龄为 44 ± 11 岁的患者纳入研究，其中 19 例接受 Lichtenstein 手术，18 例接受 TAPP 手术。两种技术的手术时间相似。Lichtenstein 组术后第 7 天疼痛更明显。两组的生化和激素分析、睾丸超声检查（多普勒、睾丸体积和形态学发现）和精子质量相似。然而，Lichtenstein 组在术后 180 天精子形态更好（与术前相比，p < 0.05），且 2 例接受 Lichtenstein 疝修补术的患者在术后 180 天出现少精子症。生活质量评估显示，术后以下领域有显著改善：生理功能、角色情感、躯体疼痛和总体健康（p < 0.05）。比较 Lichtenstein 与 TAPP 组，没有任何领域显示出统计学上的显著差异。没有患者报告有性行为变化。
使用聚丙烯网片进行双侧腹股沟疝修补术，无论是采用 Lichtenstein 还是 TAPP 技术，在长期结果方面均不会损害男性生育力。
经 HC/FMUSP 分析研究项目伦理委员会（CAPPesq）批准，编号为 2.974.457，于 2015 年 6 月批准，于 2015 年 10 月在 Plataforma Brasil 上注册，注册号为 45535015.4.0000.0068。于 Clinicaltrials.gov 上注册，注册号为 NCT05799742。于 2016 年 1 月招募首例受试者。
