Male inguinal hernia repair with mesh. Short- and long-term results and the question of infertility

Detta är en avhandling från Department of Surgery, Clinical Sciences Lund, Lund University

Sammanfattning: Background: In the nineties, the patients with inguinal hernias were exposed to several newly developed repair techniques using alloplastic mesh prosthesis. Although the scientific knowledge was limited, the new techniques were rapidly introduced due to surgical enthusiasm, but also by an eagerness to reduce the recurrence rate and to shorten the time to recovery. When the first study of this thesis was initiated there were almost no randomized controlled trials comparing the short- and long-term results of open tension free repair (Lichtenstein) and totally extraperitoneal laparoscopic repair (TEP).

The recurrence rates have since then been markedly reduced and the focus has moved towards studying other side effects of inguinal hernia surgery. The use of mesh in inguinal hernia surgery has been proposed to increase the incidence of male infertility due to inflammatory obstruction of the structures of the spermatic cord.

Aims: To compare the Lichtenstein and the TEP operation techniques regarding short- as well as long-term results. To assess the risk of male infertility following inguinal hernia mesh repair.

Methods: The first two publications were based on a prospective randomized controlled study comparing the two repair techniques, with both short- and long-term follow-up. The next two publications were derived from the Swedish Hernia Register. One was a prospective study, comparing by questionnaire, involuntary childlessness after bilateral inguinal hernia repair with or without mesh. The other was a retrospective study comparing the expected and observed incidences of diagnosed male infertility after inguinal hernia repair with or without mesh.

Results: TEP resulted in less consumption of analgesics, shorter sick leave, faster recovery, longer operation time, higher hospital costs and less impaired inguinal sensibility. In the long-term both methods had a high patient satisfaction rate, almost no impact on day-to-day life and a low frequency of persistent severe chronic pain. Bilateral inguinal hernia mesh repairs in men did not increase the incidence of involuntary childlessness. Inguinal hernia mesh repairs were not associated with a clinically important increase of diagnosed male infertility.

Conclusions: TEP and Lichtenstein are comparable techniques which both have overall good short- and long-term results. Inguinal hernia mesh repair is a safe method regarding male infertility.