Abstract：
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.
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.
摘要：
背景：疝修补术对睾丸功能的影响仍不确定，不管使用的技术。分析疝气修复或激素测量后睾丸体积和流量的研究很少，并且显示出矛盾的结果。这项研究旨在评估使用Lichtenstein和腹腔镜经腹腹膜前（TAPP）技术的手术患者双侧腹股沟疝修补术对男性生育能力的影响。
方法：对48例原发性双侧腹股沟疝成年患者（20~60岁）进行了一项随机临床试验，比较了使用聚丙烯网片的开放式（Lichtenstein）和腹腔镜（TAPP）疝修补术。患者在术前和术后90和180天（PO）进行评估。性激素（睾酮，FSH,LH和SHGB）分析，睾丸超声检查，进行精液质量性活动变化和生活质量(QoL)。使用视觉模拟量表（VAS）评估术后疼痛。
结果：共纳入37例患者，年龄44±11岁，19在列支敦士登进行手术，18在TAPP进行手术。不同技术之间的手术时间相似。在第7个PO天，Lichtenstein组的疼痛更大。生化和荷尔蒙分析，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,180天后，Lichtenstein组的精子形态更好（p<0.05vs.术前）和两名接受Lichtenstein疝修补术的患者在180天后出现少精子症。QoL评估显示手术后在以下领域有显著改善：身体功能，角色情感，身体疼痛和一般健康(p<0.05)。关于列支敦士登与列支敦士登的比较TAPP中没有一个域显示出统计学上的显著差异。没有患者报告性变化。
结论：双侧腹股沟疝修补术采用聚丙烯补片，无论是使用Lichtenstein还是TAPP，在长期结果方面不会损害男性生育能力。
背景：经HC/FMUSP研究项目分析伦理委员会（CAPPesq）批准，编号2.974.457，于2015年6月，根据《45535015.4.0000.0068号议定书》于2015年10月在巴西平台注册。在Clinicaltrials.gov上注册，NCT05799742。2016年1月注册第一个科目。
方法：对48例原发性双侧腹股沟疝成年患者（20~60岁）进行了一项随机临床试验，比较了使用聚丙烯网片的开放式（Lichtenstein）和腹腔镜（TAPP）疝修补术。患者在术前和术后90和180天（PO）进行评估。性激素（睾酮，FSH,LH和SHGB）分析，睾丸超声检查，进行精液质量性活动变化和生活质量(QoL)。使用视觉模拟量表（VAS）评估术后疼痛。
结果：共纳入37例患者，年龄44±11岁，19在列支敦士登进行手术，18在TAPP进行手术。不同技术之间的手术时间相似。在第7个PO天，Lichtenstein组的疼痛更大。生化和荷尔蒙分析，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,180天后，Lichtenstein组的精子形态更好（p<0.05vs.术前）和两名接受Lichtenstein疝修补术的患者在180天后出现少精子症。QoL评估显示手术后在以下领域有显著改善：身体功能，角色情感，身体疼痛和一般健康(p<0.05)。关于列支敦士登与列支敦士登的比较TAPP中没有一个域显示出统计学上的显著差异。没有患者报告性变化。
结论：双侧腹股沟疝修补术采用聚丙烯补片，无论是使用Lichtenstein还是TAPP，在长期结果方面不会损害男性生育能力。
背景：经HC/FMUSP研究项目分析伦理委员会（CAPPesq）批准，编号2.974.457，于2015年6月，根据《45535015.4.0000.0068号议定书》于2015年10月在巴西平台注册。在Clinicaltrials.gov上注册，NCT05799742。2016年1月注册第一个科目。
