Bilateral inguinal hernia repair and male fertility: a randomized clinical trial comparing Lichtenstein versus laparoscopic transabdominal preperitoneal (TAPP) technique.

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.

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats.

PURPOSE: To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels. METHODS: Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh - cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured. RESULTS: The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05). CONCLUSION: Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.

Alteraçöes hemodinâmicas no pneumoperitônio induzido durante cirurgias vídeo-laparoscópicas / Hemodynamic changes of induced pneumoperitoneum during laparoscopic surgery

As alteraçöes hemodinâmicas que podem ocorrer nas cirurgias vídeo-laparoscópicas em funçäo da compressäo dos vasos abdominais pela confecçäo do pneumoperitônio, levam os cirurgiöes a manter especial preocupaçäo com as possíveis repercurssöes do procedimento. O objetivo deste estudo é analisar as alteraçöes observadas em 34 pacientes ASA e ASA II, com idade variando entre 28 e 69 anos, pesando entre 49 e 85 kg, circunferência abdominal entre 70 e 110 cm, e distância xifo-pública entre 25 e 45 cm. Foram avaliados: pressäo do pneumoperitôneo (PPN), volume de gás carbônico (VCO2) insuflado, freqüência cardíaca (FC) e respiratória (FR), pressäo arterial sistólica (PAs), pressäo arterial diastólica (PAd) e pressäo arterial média (PAM), todas computadas antes da insuflaçäo peritonial no trans-operatório, em intervalos regulares de 20 min até a desinuflaçäo da cavidade abdominal. Os dados obidos foram avaliados considerando como significante p < 0,05. Foi constatado que todas as variáveis estudadas possuem alteraçöes nos diferentes intervalos de tempo, porém näo sendo estatisticamente significantes. Os resultados obtidos permitem concluir que as alteraçöes observadas säo toleradas, e näo repercutem clinicamente nos pacientes ASA I e ASA II