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Andresen K, Rosenberg J. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 2024; 7:CD004703. [PMID: 38963034 PMCID: PMC11223180 DOI: 10.1002/14651858.cd004703.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
BACKGROUND An inguinal hernia occurs when part of the intestine protrudes through the abdominal muscles. In adults, this common condition is much more likely in men than in women. Inguinal hernia can be monitored by 'watchful waiting', but if symptoms persist or worsen, surgery is usually required, which can be open or laparoscopic. Laparoscopic (keyhole) repair of inguinal hernias in adults is generally performed using either the transabdominal preperitoneal (TAPP) or the totally extraperitoneal (TEP) method. Both methods include the use of mesh placed in front of the peritoneal lining of the abdominal wall, but for the TAPP technique, the abdominal cavity needs to be entered to place the mesh, and for the TEP technique, the whole procedure is done on the outside of the peritoneal lining of the abdominall wall. Whether one method is superior to the other has not been established, and there is debate about their relative benefits and harms. An advantage of TEP is its avoidance of the abdominal cavity; the downside is that it requires a steeper learning curve for clinicians. TAPP is considered simpler and makes it possible to inspect the contralateral side, but TAPP may have a higher risk of visceral injury compared to TEP. This is an update of a Cochrane review first published in 2005. OBJECTIVES To compare the benefits and harms of laparoscopic TAPP technique versus laparoscopic TEP technique for inguinal hernia repair in adults. SEARCH METHODS On 25 October 2022, the authors searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R); and Ovid Embase, for published randomised controlled trials. To identify studies in progress, we searched ClinicalTrials.gov and the WHO International Clinical Trial Registry Platform (ICTRP). SELECTION CRITERIA All prospective randomised, quasi-randomised, and cluster-randomised trials that compared the laparoscopic TAPP technique with the laparoscopic TEP technique for inguinal hernia repair in adults were eligible for inclusion. We included studies that involved a mix of different types of groin hernia if we could extract data for the inguinal hernias. Studies may have also included a group of participants receiving hernia repair by open surgery, but these groups were not included in our review. DATA COLLECTION AND ANALYSIS Both review authors independently evaluated trial eligibility, extracted data from included studies, and assessed the risk of bias in the included studies. The review's primary outcomes were serious adverse events, chronic pain (persisting for at least six months after surgery), and hernia recurrence. We also assessed a variety of secondary outcomes at perioperative, early postoperative, and late postoperative time points. We performed statistical analyses using the random-effects model, and expressed the results as odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, with their respective 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence for key outcomes as high, moderate, low or very low. MAIN RESULTS We included 23 studies in this review update, which randomised 1156 people to TAPP and 1110 people to TEP, all requiring repair of inguinal hernias. Study sample sizes varied from 40 to 316 participants. The vast majority of study participants were male. We judged most studies to be at 'high' or 'unclear' risk of bias. Our judgements of the certainty of the evidence were low or very low for all outcomes we assessed. There may be little to no difference between TAPP and TEP laparoscopic techniques for serious adverse events (0.4% versus 0.7%; OR 0.58, 95% CI 0.15 to 2.32, P = 0.45, I2 = 0%; 19 studies, 1735 participants; low certainty of evidence); and hernia recurrence (1.2% versus 1.1%; OR 1.14, 95% CI 0.49 to 2.62, P = 0.97, I2 = 0%; 17 studies, 1712 participants; low certainty of evidence). The evidence is very uncertain about the effects of TAPP versus TEP techniques on chronic pain (OR 0.62, 95% CI 0.20 to 1.97, P = 0.68, I2 = 0%; 6 studies, 860 participants; very low certainty of evidence). In terms of secondary outcomes, the evidence is very uncertain for TAPP versus TEP techniques for perioperative visceral and vascular injury (15 studies, 1523 participants; very low certainty of evidence), and for haematoma or seroma during the early (≤ 30 days) postoperative phase (OR 0.86, 95% CI 0.54 to 1.37, P = 0.3861, I2 = 0%; 15 studies, 1423 participants; very low certainty of evidence). TEP technique may carry a higher risk of conversion to another hernia repair method (either TAPP technique or open surgery) when compared to TAPP (2.5% versus 0.7%; OR 0.28, 95% CI 0.09 to 0.84, P = 0.02, I2 = 0%; 13 studies, 1178 participants; low certainty of evidence). Only two studies (474 participants) reported quality of life in the late (> 30 days) postoperative phase; overall, there was an improvement in quality of life from the pre- to post-operative assessment, but the evidence suggests little to no difference between the techniques (low certainty of evidence). AUTHORS' CONCLUSIONS This review update found that there may be little to no difference between the TAPP and TEP techniques for serious adverse events, hernia recurrence, or chronic pain (low- to very-low-certainty evidence). Decisions about which method to use will most likely reflect surgeon and patient preference until high-certainty evidence becomes available. There may be a higher risk of needing to convert from TEP to TAPP or open surgery when compared to the risk of needing to convert from TAPP to open surgery (low-certainty evidence). If surgeons opt for TEP as their standard laparoscopic method, they could consider having a strategy for how to handle the potential need for conversion. This might include proficiency in the TAPP approach or having informed the patient about the risk of conversion to open surgery. For surgeons or surgical departments, the choice of a laparoscopic technique should involve shared decision-making with patients and their families or carers. Future research could focus on patient-reported outcomes, such as quality of life.
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Affiliation(s)
- Kristoffer Andresen
- Department of Surgery, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Jacob Rosenberg
- Department of Surgery, University of Copenhagen, Herlev Hospital, Herlev, Denmark
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Damous SHB, Damous LL, Borges VA, Fontella AK, Miranda JDS, Koike MK, Saito OC, Birolini CAV, Utiyama EM. Bilateral inguinal hernia repair and male fertility: a randomized clinical trial comparing Lichtenstein versus laparoscopic transabdominal preperitoneal (TAPP) technique. Surg Endosc 2023; 37:9263-9274. [PMID: 37880447 DOI: 10.1007/s00464-023-10499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND 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. METHODS 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). RESULTS 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. CONCLUSION Bilateral inguinal hernia repair with polypropylene mesh, whether using Lichtenstein or TAPP, does not impair male fertility in terms of long-term outcomes. TRIAL REGISTRATION 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.
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Affiliation(s)
- Sérgio Henrique Bastos Damous
- 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.
| | - Luciana Lamarão Damous
- 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
- Postgraduate Program in Health Sciences, Instituto de Assistência Médica do Servidor Público Estadual (IAMSPE), São Paulo, Brazil
| | - Victor André Borges
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Jocielle Dos Santos Miranda
- 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
| | - Marcia Kiyomi Koike
- Postgraduate Program in Health Sciences, IAMSPE and Laboratory of Medical Investigation 51 (LIM-51), University of São Paulo, São Paulo, Brazil
| | - Osmar Cássio Saito
- Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), São Paulo, Brazil
| | - Cláudio Augusto Vianna Birolini
- 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
| | - Edivaldo Massazo Utiyama
- 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
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Lu J, Zhao X, Yue F, Xue P, Feng B, Chen Q, Li J. Laparoscopic Inguinal Hernia Repair for Female Patients: Experience from a High-volume Center in 20 years. Surg Laparosc Endosc Percutan Tech 2023; 33:622-626. [PMID: 37852236 DOI: 10.1097/sle.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Although laparoscopic inguinal hernia repair (LIHR) is widely performed worldwide, few studies have focused on the procedure in female patients. This study investigated the characteristics and outcomes of female patients with inguinal hernias who underwent LIHR. MATERIALS AND METHODS This study retrospectively analyzed the data of 7380 patients with inguinal hernia admitted to the General Surgery Department of Ruijin Hospital and underwent LIHR from January 2001 to December 2020. The clinical characteristics, surgical outcomes, and complications were assessed. RESULTS In total, 572 female patients were enrolled in this study. The proportion of femoral hernias in female patients was higher in women than in male patients (17.4% vs. 0.3%, respectively). Mesothelial cysts of the round uterine ligament (MCURL) were noted in 74 patients. The mean age of patients with MCURL was lower than that of patients without MCURL (46.4 vs. 55.6, P =0.018). Seventy cases (93.3%) of MCURL were resected laparoscopically, and 5 cases were resected through an auxiliary small incision. The round ligament was cut off in 335 patients and preserved in 237. No significant differences were observed in the number of hospitalization days, recurrence rates, or complications between the transection and preservation groups. None of the cases were converted to laparotomy, and no recurrence was noted during follow-up. CONCLUSION LIHR is safe and feasible in female patients. Treatment of femoral hernia, MCURL, and the round ligament of the uterus should be carefully considered during LIHR in female patients.
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Affiliation(s)
- Jingfeng Lu
- Department of General Surgery, Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China
- Department of General Surgery, Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Shanghai, China
| | - Xuan Zhao
- Department of General Surgery, Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Yue
- Department of General Surgery, Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - Pei Xue
- Department of General Surgery, Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Feng
- Department of General Surgery, Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Chen
- Department of General Surgery, Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Shanghai, China
| | - Jianwen Li
- Department of General Surgery, Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China
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Nethaji K, Kumari R, Jaiswal P, Jha PK, Ranjan R, Akela A. Comparison of Extended Total Extraperitoneal (E-TEP) Repair and Trans-Abdominal Pre-Peritoneal (TAPP) Mesh Repair in Inguinal Hernia Repair. Cureus 2023; 15:e39420. [PMID: 37362494 PMCID: PMC10288329 DOI: 10.7759/cureus.39420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND AND AIM To find the superiority of extended total extraperitoneal (E-TEP) repair and trans-abdominal pre-peritoneal (TAPP) mesh repair in inguinal hernia repair. MATERIAL AND METHODS A total of 30 patients with a unilateral or bilateral inguinal hernia (IH), and recurrent IH, following open repair were studied. Out of 30 patients, laparoscopic TAPP or E-TEP mesh repair was performed in an equal number of inguinal hernia patients. The patient's demographic parameters, duration of surgery, postoperative hospital stay, and complications were compared. RESULTS In the E-TEP group, 33.33% of patients had left inguinal hernia (LIH), 60% of patients were diagnosed with right inguinal hernia (RIH) and 6.67% of patients had right inguinal and right direct hernia (RDH). In the TAPP group, 33.33% of patients had LIH and 53.33% of patients were suffering from RIH. Moreover, 6.67% of patients were diagnosed with a left inguinal direct hernia, and a similar proportion of patients had a right inguinal direct hernia. The mean duration of surgery was found to be significantly higher in the TAPP group (P<0.0000). The mean postoperative hospital stay was 2.07±0.59 and 2.80±1.32 days in E-TEP and TAPP groups, respectively (P=0.044). CONCLUSION In the present study, E-TEP mesh repair is a superior technique in the management of inguinal hernia as compared with TAPP repair.
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Affiliation(s)
- Kancham Nethaji
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rinku Kumari
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Pradeep Jaiswal
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Pawan K Jha
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rajeev Ranjan
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Ankur Akela
- Urology, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Gutlic A, Rogmark P, Gutlic N, Petersson U, Montgomery A. Pain with sexual activity at 1 and 3 years: Comparing total extraperitoneal with Lichtenstein inguinal hernia repair in a randomized setting (TEPLICH trial). Surgery 2022; 172:1463-1470. [PMID: 36038370 DOI: 10.1016/j.surg.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Pain at sexual activity induced by an inguinal hernia or as a cause of its repair is not thoroughly studied. Reported frequencies are between 25% and 30% preoperatively and 10% and 15% postoperatively. The primary aim was to analyze pain at sexual activity at 1 year comparing total extraperitoneal with Lichtenstein repair in a randomized setting. METHODS Men, 30 to 60 years old, with a primary inguinal hernia were randomized to total extraperitoneal without mesh fixation or Lichtenstein repair. A questionnaire on pain prevalence, frequency, intensity, and impairment of sexual functions caused by pain at sexual activity was introduced. Clinical examination, a questionnaire on sexual function, and the 36-Item Short Form Survey were performed preoperatively and at 1 and 3 years postoperatively. A risk factor analysis for pain at sexual activity as performed. RESULTS A total of 243 patients (111 total extraperitoneal and 132 Lichtenstein) were included between 2008 and 2014; 97% remained for 1-year and 90% for 3-year analysis. Preoperative pain at sexual activity was reported in 35%, with a reduction to 5.9% in total extraperitoneal and 12.5% in Lichtenstein (P = .098) at 1 year and 7.0% in total extraperitoneal and 9.3% in Lichtenstein (P = .566) at 3 years. Quality of life preoperatively was markedly reduced in patients with pain at sexual activity but restored almost to norm levels at 1 and 3 years. New pain at sexual activity (harm) was seen in 8 patients (3.6%) at 1 year. Risk factors for having postoperative pain at sexual activity were preoperative pain and Lichtenstein technique. CONCLUSION Pain at sexual activity in inguinal hernia patients is more common than suspected and reduces quality of life. Repair will markedly reduce pain at sexual activity and restore quality of life in most patients without difference between techniques. Patients should be informed on a potential relation between having an inguinal hernia and sexual impairment.
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Affiliation(s)
- Allan Gutlic
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden.
| | - Peder Rogmark
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Nihad Gutlic
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Ulf Petersson
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Agneta Montgomery
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
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Rodha MS, Meena SP, Premi K, Sharma N, Puranik A, Chaudhary R. Pain After Transabdominal Preperitoneal (TAPP) or Totally Extraperitoneal (TEP) Technique for Unilateral Inguinal Hernia: A Randomized Controlled Trial. Cureus 2022; 14:e24582. [PMID: 35651419 PMCID: PMC9138334 DOI: 10.7759/cureus.24582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Laparoscopic inguinal hernia repair is the most commonly performed surgery in many hospitals. This study aimed to compare the outcome of the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques in unilateral, uncomplicated inguinal Hernia. Material and methods This prospective randomized study was conducted in a tertiary care hospital in North India from November 2018 to March 2020. Sixty-eight male patients of unilateral, uncomplicated inguinal hernia were enrolled for laparoscopic hernia repair. The first group of 34 patients underwent TAPP repair and the second group of 34 patients underwent TEP repair under general anesthesia (GA). Both groups were compared for intraoperative or postoperative complications, analgesic requirements, postoperative pain, length of hospital stay, resumption of routine activity, and patient satisfaction scores. Fisher's exact test or Chi-square test were used for nominal data and the median or interquartile range was used for ordinal data. Results The mean operative time for TAPP was more than that for the TEP group (101 vs 76, p<0.001). The TAPP group exhibited significantly less postoperative pain at six hours, 24 hours and seven days than TEP (p<0.001) and an insignificant difference at three months of the follow-up period (p=0.188). Additional analgesics requirement was less in the TAPP group, although the difference was not significant (p=0.099). Seroma formation was found in four patients (11.8%) in the TEP group and two patients (5.9%) in the TAPP group (p= 0.672). Length of postoperative hospital stay (p=0.907), resumption of routine activity (p=0.732), and patient satisfaction scores (p=0.492) during follow-up were similar in both groups and were also insignificant. Conclusion The TAPP technique is slightly better than TEP for inguinal hernia in terms of lesser postoperative pain with similar chances of complications and other outcomes.
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Castro GRA, Zilles A, Gazzola LD, Barros RB, Sadowski JA, Guetter CR. LAPAROSCOPIC INGUINAL HERNIA REPAIR: THE LONG-TERM ASSESSMENT OF CHRONIC PAIN AND QUALITY OF LIFE. ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1695. [DOI: 10.1590/0102-672020220002e1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022]
Abstract
ABSTRACT BACKGROUND: Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction. OBJECTIVE: This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair. METHODS: This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021. RESULTS: A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument (SF-36 and Visual Analog Scale). Mean patient-reported pain (Visual Analog Scale score) was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples. CONCLUSION: Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal.
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Aykanat IC, Er S, Senel C, Comcali B, Aslan Y, Balci M, Yuksel BC, Tuncel A. Comparison of the impact of open and laparoscopic inguinal hernia operations on male sexual function and pain during sexual activity. Andrologia 2021; 54:e14254. [PMID: 34558739 DOI: 10.1111/and.14254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022] Open
Abstract
In the current study, we aimed to compare sexual function and pain during the sexual activity of men who underwent surgery with the open or laparoscopic total extraperitoneal hernia repair techniques. Patients were randomised into two groups according to the technique used during the operation: the Lichtenstein hernia repair open technique (n = 63) and the laparoscopic total extraperitoneal repair technique (n = 57). In both groups, postoperative sexual function score was significantly improved compared with the preoperative period (p < .001 for both), but the change was higher in the laparoscopy group (6.8 ± 3.7) compared with the open group (4.3 ± 4.4) (p < .001). In both groups, postoperative pain during sexual activity score was significantly decreased compared with the preoperative period (p = .001 for the open group and p < .001 for the laparoscopy group), with the amount of decrease being higher in the laparoscopy group (1.8 ± 0.9) compared with the other (1.1 ± 1.4) (p = .002). This study showed that both hernia repair techniques had a positive impact on sexual function and pain during sexual activity. The improvement in sexual parameters and pain during sexual intercourse was better in the laparoscopy group.
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Affiliation(s)
- Ibrahim C Aykanat
- Department of Urology, Ministry of Health, Yozgat State Hospital, Yozgat, Turkey
| | - Sadettin Er
- Department of General Surgery, School of Medicine, University of Health Sciences, Ankara State Hospital, Ankara, Turkey
| | - Cagdas Senel
- Department of Urology, School of Medicine, Balikesir University, Balikesir, Turkey
| | - Bulent Comcali
- Department of General Surgery, School of Medicine, University of Health Sciences, Ankara State Hospital, Ankara, Turkey
| | - Yilmaz Aslan
- Department of Urology, School of Medicine, University of Health Sciences, Ankara State Hospital, Ankara, Turkey
| | - Melih Balci
- Department of Urology, School of Medicine, University of Health Sciences, Ankara State Hospital, Ankara, Turkey
| | - Bulent C Yuksel
- Department of General Surgery, School of Medicine, University of Health Sciences, Ankara State Hospital, Ankara, Turkey
| | - Altug Tuncel
- Department of Urology, School of Medicine, University of Health Sciences, Ankara State Hospital, Ankara, Turkey
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Huang LC, Wu CC, Kang YN. Comment on 'Do TEP and TAPP have similar effect on postoperative pain? Author's reply'. Hernia 2021; 25:1405-1406. [PMID: 34460017 DOI: 10.1007/s10029-021-02480-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- L-C Huang
- Department of Urology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - C-C Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan. .,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Y-N Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Xing-Long Road, Taipei, 11696, Taiwan. .,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. .,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Aiolfi A, Bonitta G. Do TEP and TAPP have similar effect on postoperative pain? Author's reply. Hernia 2021; 25:1403-1404. [PMID: 34138369 DOI: 10.1007/s10029-021-02447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- A Aiolfi
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | - G Bonitta
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
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Huang LC, Wu CC, Kang YN. Do TEP and TAPP have similar effect on postoperative pain? Hernia 2021; 25:1401-1402. [PMID: 33991250 DOI: 10.1007/s10029-021-02426-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/06/2021] [Indexed: 01/09/2023]
Affiliation(s)
- L-C Huang
- Department of Urology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - C-C Wu
- Department of Urology, Taipei Medical University Hospital, No. 252 Wu Hsing Street, Taipei, 110, Taiwan. .,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Y-N Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University No, 111, Section 3, Xing-Long Road, Taipei, 11696, Taiwan. .,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. .,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
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12
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Hung TY, Wu CC, Chen LS, Kang YN. Safety of two common laparoscopic inguinal herniorrhaphy approaches: an updated systematic review with meta-analysis of randomized clinical trials. Transl Androl Urol 2020; 9:2007-2021. [PMID: 33209665 PMCID: PMC7658174 DOI: 10.21037/tau-20-629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Previous evidence indicated that total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) are advantageous in efficacy of inguinal herniorrhaphy. Therefore, our aim in this study was to evaluate the association of the two laparoscopic approaches on safety of inguinal herniorrhaphy. Methods In this update study, we searched the Cochrane Library, EMBASE, PubMed, Scopus, and Web of Science and identified randomized clinical trials comparing complications in TEP and TAPP herniorrhaphy. We mainly used Peto odds ratio with 95% confidence interval (CI) for meta-analysis because of zero-cell. Results Fourteen eligible trials recruited 659 and 682 patients in TEP and TAPP respectively. In overall pooling, although TEP had a higher seroma rate than TAPP (Peto odds ratio =2.01; 95% CI, 1.39 to 2.91), it had a lower scrotal/cord edema rates at immediate postoperative (Peto odds ratio =0.22; 95% CI, 0.09 to 0.57) and 1 week after inguinal hernia repair (Peto odds ratio =0.58; 95% CI, 0.37 to 0.91) than TAPP. Conclusions TEP and TAPP have their own advantages in inguinal herniorrhaphy. TAPP was associated with a lower seroma rate, and TEP was associated with a lower edema rate. Therefore, shared decision-making on laparoscopic inguinal herniorrhaphy with TEP and TAPP is still needed.
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Affiliation(s)
- Tsung-Yu Hung
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei.,School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chien-Chih Wu
- Department of Urology, Taipei Medical University Hospital, Taipei.,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Li-Siou Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Physical Medicine and Rehabilitation, Taipei Chang Gung Memorial Hospital, Taipei
| | - Yi-No Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei.,Cochrane Taiwan, Taipei Medical University, Taipei.,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei
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Sarakatsianou C, Baloyiannis I, Perivoliotis K, Georgopoulou S, Tzovaras G. Quality of life after laparoscopic trans-abdominal pre-peritoneal inguinal hernia repair: spinal vs general anesthesia. Hernia 2020; 25:789-796. [PMID: 33000326 DOI: 10.1007/s10029-020-02313-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the effect of the anesthesia type on the postoperative quality of life in patients who underwent trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair. METHODS In this study, 70 patients submitted to TAPP for inguinal hernia repair, were randomized between spinal and general anesthesia. Overall, 58 patients completed the follow-up process and were, therefore, included. The quality of life evaluation was based on the SF-36 questionnaire. Significance was considered at the level of P < 0.05 RESULTS: General anesthesia was applied to 31 patients, whereas 27 operations were performed under spinal anesthesia. Except gender, the two study subgroups were similar in terms of demographics. Although spinal anesthesia displayed higher energy, emotional health, and general health scores these findings were not statistically significant. A positive correlation was identified between age and physical and emotional role. Operative time was associated with the estimated energy and general health. CONCLUSION Our study could not identify a difference between spinal and general anesthesia on the postoperative quality of life. Spinal anesthesia is as effective as general anesthesia and remains an attractive anesthetic alternative for TAPP inguinal hernia repair. Given several study limitations, further high-quality trials are required.
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Affiliation(s)
- C Sarakatsianou
- Department of Anesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
| | - I Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - K Perivoliotis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - S Georgopoulou
- Department of Anesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - G Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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14
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Effects of totally extraperitoneal and lichtenstein hernia repair on men's sexual function and quality of life. Surg Endosc 2019; 34:1103-1111. [PMID: 31161289 DOI: 10.1007/s00464-019-06857-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In the literature, there have been scant studies that compare the effects of totally extraperitoneal (TEP) and Lichtenstein hernia (LH) repairs on men's sexual function and quality of life. Our aim in this study was to study the sexual function of men after TEP and LH repair according to SF 36 (Health Survey Scoring Demonstration) and IIEF (The International Index of Erectile Function). METHODS A total of 176 men with unilateral inguinal hernia were randomized into two groups. Group T (n = 88) received TEP hernia repair, and Group L (n:88) received LH repair. Patients' demographics and perioperative findings were recorded. For all patients, the preoperative as well as postoperative 7th, 30th and 90th day SF 36 and IIEF were recorded. RESULTS A total of 176 operations consisting of 88 TEP and 88 LH repairs were evaluated. There were no differences in demographics, hernia type, and complications except for body mass index (BMI). The operative time was higher in Group T (29.6 ± 5.8 vs. 43.5 ± 5.7 min; p = 0.001). The averages of the SF 36-Vitality and Social Function for Postoperative (PO) 30th day scores were higher in Group T. The averages of the SF 36-Bodily Pain, General Health, Physical Role, Emotional Role for PO 7-30th days SF36- Mental Health for PO 7th day and SF 36 Physical Function for PO 30-90th days scores were statistically higher in Group T. The averages of the IIEF- Erectile Function for PO 30th day, IIEF- Orgasmic Function, Sexual Desire, Intercourse Satisfaction, and Intercourse Satisfaction for PO 7th and 30th days scores were higher in Group T. CONCLUSIONS TEP and LH repairs have similar results for recurrence, complications, and hospital stay; otherwise, TEP repair yields better results than the LH repair in the postoperative course at the 7th and 30th day evaluation, concerning sexual function and quality of life, but this benefit is no longer apparent at the 90th day. Although the short-term differences were statistically significant, they were moderate and might have a limited impact from the clinical point of view.
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Köckerling F. TEP for elective primary unilateral inguinal hernia repair in men: what do we know? Hernia 2019; 23:439-459. [PMID: 31062110 PMCID: PMC6586704 DOI: 10.1007/s10029-019-01936-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/26/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Based on the new international guidelines for groin hernia management, there is no one surgical technique that is suited to all patient characteristics and diagnostic findings. Therefore, a tailored approach should be used. Here, a distinction must be made between primary unilateral inguinal hernia in men and in women, bilateral inguinal hernia, scrotal inguinal hernia, inguinal hernia following pelvic and lower abdominal procedures, patients with severe cardiopulmonary complications, recurrent inguinal hernias and incarcerated inguinal and femoral hernias. This paper now explores the relevant studies on TEP for elective primary unilateral inguinal hernia in men, which constitutes the most common indication for repair. MATERIAL A systematic search of the available literature was performed in February 2019 using Medline, PubMed, Scopus, Embase, Springer Link and the Cochrane Library. Only meta-analyses, systematic reviews, RCTs and comparative registry studies were considered. 117 publications were identified as relevant. RESULTS RCTs and comparative registry analyses demonstrated the advantages of TEP with regard to postoperative complications, complication-related reoperations, and postoperative and chronic pain compared with Lichtenstein repair for elective primary unilateral inguinal hernia repair in men. No relevant differences were found compared with TAPP. Mesh fixation is not needed in TEP, but heavyweight meshes result in a lower recurrence rate. Extraperitoneal bupivacaine analgesia vs placebo does not demonstrate any advantages, but drainage is advantageous for seroma prophylaxis. The risk of chronic pain is negatively influenced by small defects, younger patient age, preoperative pain, higher BMI, postoperative complications, higher ASA score and risk factors. CONCLUSION For the subgroup of elective primary unilateral inguinal hernia in men, accounting for a proportion of less than 50% of the total collective, advantages were identified for TEP compared with open Lichtenstein repair but not versus TAPP.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
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Chen LS, Chen WC, Kang YN, Wu CC, Tsai LW, Liu MZ. Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair: an update systematic review and meta-analysis of randomized controlled trials. Surg Endosc 2018; 33:418-428. [PMID: 29987564 DOI: 10.1007/s00464-018-6314-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 06/29/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Compared with open herniorrhaphy, laparoscopic herniorrhaphy can yield more favorable clinical outcomes. However, previous studies failed to give definite answer for comparison between laparoscopic inguinal hernia repair approaches. This study aimed to systematically determine the differences in recurrence rate, duration of return to work, pain, surgery duration, and duration of hospital stay between transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approach for inguinal hernia. METHODS PubMed, Embase, and Cochrane Library (including the Cochrane Central Register of Controlled Trials) abstracts up to September 2017 were searched for randomized controlled trials (RCTs) comparing TAPP or TEP hernia repairing. The hernia recurrence rate, time to return to work, analgesic consumption, surgery duration, hospital stay, and the pain score were recorded with subgroup analysis of the hernia type. RESULTS Sixteen RCTs that randomized 1519 patients with hernia into TEP and TAPP repair groups were analyzed in this study. The results revealed that TEP repair resulted in shorter hospital stay of primary cases (MD - 0.87, 95% CI - 1.67 to - 0.07) but was associated with a longer operative duration in recurrent hernia group (MD 3.35, 95% CI 0.16 - 6.54). CONCLUSIONS TEP and TAPP have their own advantages. TEP repair reduces short-term postoperative pain more effectively than TAPP repair and results in shorter hospital stay of primary cases. In contrast, TAPP repair is correlated with shorter surgery duration. These findings show that shared decision-making regarding both approaches of laparoscopic hernia repair may be needed.
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Affiliation(s)
- Li-Siou Chen
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chieh Chen
- Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan
| | - Yi-No Kang
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan. .,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chien-Chih Wu
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.,Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Long-Wen Tsai
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan
| | - Min-Zhe Liu
- Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.
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Dong Z, Kujawa SA, Wang C, Zhao H. Does the use of hernia mesh in surgical inguinal hernia repairs cause male infertility? A systematic review and descriptive analysis. Reprod Health 2018; 15:69. [PMID: 29688866 PMCID: PMC5914038 DOI: 10.1186/s12978-018-0510-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 04/18/2018] [Indexed: 12/30/2022] Open
Abstract
Objective The aim of this study was to systematically review the available clinical trials examining male infertility after inguinal hernias were repaired using mesh procedures. Methods The Cochrane Library, PubMed, Embase, Web of Science, and Chinese Biomedical Medicine Database were investigated. The Jada score was used to evaluate the quality of the studies, “Oxford Centre for Evidence-based Medicine-Levels of Evidence” was used to assess the level of the trials, and descriptive analysis was used to evaluate the studies. Results Twenty nine related trials with a total of 36,552 patients were investigated, including seven randomized controlled trials (RCTs) with 616 patients and 10 clinical trials (1230 patients) with mesh or non-mesh repairs. The Jada score showed that there were six high quality RCTs and one low quality RCT. Levels of evidence determined from the Oxford Centre for Evidence-based Medicine further demonstrated that those six high quality RCTs also had high levels of evidence. It was found that serum testosterone, LH, and FSH levels declined in the laparoscopic group compared to the open group; however, the testicular volume only slightly increased without statistical significance. Testicular and sexual functions remained unchanged after both laparoscopic transabdominal preperitoneal hernia repair (TAPP) and totally extra-peritoneal repair (TEP). We also compared the different meshes used post-surgeries. VyproII/Timesh lightweight mesh had a diminished effect on sperm motility compared to Marlex heavyweight mesh after a one-year follow-up, but there was no effect after 3 years. Additionally, various open hernia repair procedures (Lichtenstein, mesh plug method, posterior pre-peritoneal mesh repair, and anterior tension-free repair) did not cause infertility. Conclusions This systematic review suggests that hernia repair with mesh either in an open or a laparoscopic procedure has no significant effect on male fertility.
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Affiliation(s)
- Zhiyong Dong
- Department of Surgery, the First Affiliated Hospital of Jinan University, No. 613. Huangpu Avenue West, Guangzhou, 510630, China.,Robert H. Lurie Comprehensive Cancer center, Division of Reproductive Science in Medicine, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Suite 4-121, Chicago, IL, 60611, USA
| | - Stacy Ann Kujawa
- Robert H. Lurie Comprehensive Cancer center, Division of Reproductive Science in Medicine, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Suite 4-121, Chicago, IL, 60611, USA
| | - Cunchuan Wang
- Department of Surgery, the First Affiliated Hospital of Jinan University, No. 613. Huangpu Avenue West, Guangzhou, 510630, China.
| | - Hong Zhao
- Robert H. Lurie Comprehensive Cancer center, Division of Reproductive Science in Medicine, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Suite 4-121, Chicago, IL, 60611, USA.
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