Iatrogenic vas deferens injury due to inguinal hernia repair

Sexual dysfunction between laparoscopic and open inguinal hernia repair: a systematic review and meta-analysis

PURPOSE

Sexual dysfunction after inguinal hernia complication is considered rare. However, its consequences impact on quality of life inevitably. Laparoscopic and open inguinal hernia repair may be comparable in terms of recurrent rate, overall complications, and chronic pain. Therefore, its complication is still questionable between these approaches. In this study, we compared sexual dysfunction and related complications between laparoscopic and open inguinal hernia repair.

METHODS

Systematic review and meta-analysis of randomized controlled trials (RCTs) studies were performed to compare laparoscopic and open inguinal hernia repair. Risk ratio (RR) and 95% confidence intervals (95% CI) were used as pooled effect size measures.

RESULT

Thirty RCTs (12,022 patients) were included. Overall, 6014 (50.02%) underwent laparoscopic hernia repair, and 6008 (49.98%) underwent open hernia repair. Laparoscopic approach provided non-significance benefit on pain during sexual activity (RR 0.57; 95% CI 0.18, 1.76), Vas deferens injury (RR 0.46; 95% CI 0.13, 1.63), orchitis (RR 0.84; CI 0.61,1.17), scrotal hematoma (RR 0.99; CI 0.62,1.60), and testicular atrophy (RR 0.46; CI 0.17,1.20). Meanwhile, the open inguinal hernia approach seems to perform better for cord seroma complications and testicular pain.

CONCLUSION

There is no advantage of laparoscopic inguinal hernia repair over an open approach concerning sexual dysfunction. On the contrary, there is an increasing risk of cord seroma after laparoscopic inguinal hernia repair with statistical significance.

Microsurgically Assisted Inguinal Hernia Repair and Simultaneous Male Fertility Procedures: Rationale, Technique and Outcomes

PURPOSE

Inguinal herniorrhaphy is the most common general surgical procedure. It is associated with frequent complications such as recurrence in 2.0% to 14.1% of cases with mesh as well as postoperative hematoma in 4.5% of cases, reduced sensation in 0% to 42.8%, chronic postoperative pain in 5.1%, vasal injury in 0.1% to 0.53% and infection in 3% to 6%. Drawing on our experience with the operating microscope for varicocelectomy, vasectomy reversal and repair of iatrogenic vasal obstruction from hernia repair, we applied the operating microscope for inguinal hernia repair. This study describes the rationale, technique and outcomes of microsurgically assisted inguinal hernia repair.

MATERIALS AND METHODS

A total of 291 microsurgically assisted inguinal hernia repairs were performed in 253 men by the same urologist (MG). Simultaneous microsurgical varicocelectomy or other testicular procedures were performed in 83% of cases. All were open repairs through an inguinal incision with the vas deferens, ilioinguinal nerve, genital branch of the genitofemoral nerve, and spermatic vasculature identified and preserved. Median followup was 8.6 months. Outcomes were assessed by examination, pain reporting and pathology reports.

RESULTS

Chronic postoperative pain, sensory loss, infection, hematoma, vasal injury and recurrence were assessed. The incidence of hematoma was 0.85%. No recurrent hernia, chronic postoperative pain, sensory loss, infection or vasal injury was reported.

CONCLUSIONS

Using an operating microscope the complications of inguinal hernia repair, such as vasal obstruction, testicular atrophy, recurrence, infection, hematoma, chronic postoperative pain and loss of sensation, are minimized. Microsurgically assisted hernia repair is a promising technique, especially when performed by a urologist who simultaneously performs microsurgical varicocelectomy or procedures involving spermatic cord structures or the testis.