Can Inguinal Hernia Repair Cause Low Testosterone

Reprod Wellness. 2022; fifteen: 69.

Does the use of hernia mesh in surgical inguinal hernia repairs crusade male infertility? A systematic review and descriptive assay

Zhiyong Dong

¹Department of Surgery, the Beginning Affiliated Hospital of Jinan University, No. 613. Huangpu Avenue West, Guangzhou, 510630 Prc

ⁱⁱRobert H. Lurie Comprehensive Cancer center, Division of Reproductive Science in Medicine, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Suite iv-121, Chicago, IL 60611 United states

Stacy Ann Kujawa

²Robert H. Lurie Comprehensive Cancer center, Division of Reproductive Science in Medicine, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Suite iv-121, Chicago, IL 60611 USA

Cunchuan Wang

¹Section of Surgery, the Outset Affiliated Hospital of Jinan University, No. 613. Huangpu Avenue Due west, Guangzhou, 510630 China

Hong Zhao

²Robert H. Lurie Comprehensive Cancer center, Sectionalisation of Reproductive Science in Medicine, Feinberg School of Medicine, Northwestern Academy, 303 E. Superior Street, Suite 4-121, Chicago, IL 60611 United states

Received 2022 Jul xiv; Accustomed 2022 April xviii.

Abstruse

Objective

The aim of this report 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 Center 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 full 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 in that location were half dozen high quality RCTs and ane 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 establish 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 later both laparoscopic transabdominal preperitoneal hernia repair (TAPP) and totally extra-peritoneal repair (TEP). We besides compared the dissimilar meshes used mail service-surgeries. VyproII/Timesh lightweight mesh had a diminished consequence on sperm motility compared to Marlex heavyweight mesh after a ane-year follow-up, merely there was no effect afterward iii years. Additionally, various open up hernia repair procedures (Lichtenstein, mesh plug method, posterior pre-peritoneal mesh repair, and anterior tension-free repair) did non 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.

Keywords: Inguinal hernia repair, Mesh, Male person infertility, Systematic review

Obviously English language summary

The incidence of inguinal hernia is steadily decreasing subsequently the application of mesh and laparoscopic techniques; notwithstanding the utilise of mesh causing infertility is becoming a growing concern. Whether in that location are any effects on male fertility after open/laparoscopic mesh inguinal hernia repair is yet a controversial topic. Thus, the aim of this study was to systematically review the available clinical trials for male infertility after inguinal hernia repair with mesh. The Jada score and Oxford Centre for EBM Levels of Evidence were used to evaluate the quality or evidence level of the included studies. Finally, 29 related trials were investigated. The results indicated that polypropylene mesh inguinal repair did non change male infertility after open or laparoscopic mesh repair, TAPP versus TEP additional procedures of repair, or assorted mesh types. This report suggests that hernia repair with mesh either in an open or a laparoscopic process has no significant upshot on male infertility according to current show. However, whether sperm should exist stored and assessed for quality purposes prior to procedures for patients who accept fertility issues, is worthy of further study.

Groundwork

Tension-free mesh hernia repair has get the standard procedure in inguinal hernia repair after the concept of tension-free hernia repair was proposed by Lichtenstein in 1989 [1]. Currently, the main operating procedures for inguinal hernia repair involve either open or laparoscopic hernia repair with mesh [2, three]. The meshes used for these procedures are equanimous of biomaterial or biological fabric including polypropylene, Marlex, VyproII, TiMesh, and Prolene [4, five]. The incidence of inguinal hernia has decreased after the awarding of mesh and laparoscopic techniques, but the utilize of mesh causing infertility is becoming a growing concern.

It has been reported that the complications of mesh hernia repair are infection, pain, adhesions, seroma, intestinal obstacle, and recurrence [vi, 7]. Indicators for diagnosing male infertility usually include the testicular volume, testicular resistivity index, serum testosterone, serum gonadotrophins (FSH, follicle-stimulating and LH, luteinizing hormone), and semen quality (volume, concentration, motion, α-glucosidase, and morphology). Mesh inguinal hernia repair may cause infertility by influencing the spermatic duct construction in white male person rats [8]. In men, fourteen cases of azoospermia secondary to inguinal vasal obstacle were reported in relation to previous polypropylene mesh hernia repair [ix]. A randomized controlled trial (RCT) with 59 male patients was used to evaluate male fertility between heavyweight meshes (Marlex) and lightweight meshes (Vypro II/TiMesh) at a one-yr follow-up. Semen analysis showed that lightweight meshes for laparoscopic inguinal hernia repair negatively influenced sperm motility [10]. Contrarily, Tekatili et al. summarized 16 clinical studies and indicated that the lightweight mesh did not seem to accept an bear on on male fertility in inguinal hernias [xi]. The only previous systemic review likewise supported that at that place is not an affect on male fertility later on mesh hernia repairs [12]. Therefore, the part of mesh usage in male fertility in hernia repair patients remains unclear.

To circumvent the limitation of the previous review, nosotros have included several additional RCTs and control trials on male infertility and hernia repair published from 2022 to 2022 [12–19], detailed sub-grouping analyses, and additional databases and clinical trials. In addition, the Jada score and levels of evidence from Oxford Eye for Evidence-based Medicine were used to assess the quality of included studies. Our well-nigh comprehensive systemic review analyzed the possible effect of mesh usage on male fertility in hernia repair, including unlike open up and laparoscopic procedures and various types of surgical mesh. This study provides a robust evidence-based answer to support clinical decisions.

Methods

Search strategy

The related literature was searched on Feb 14th, 2022 from the following electronic databases: PubMed, Embase, Primal (Cochrane Library), Web of Science, CBM (Chinese Biomedical Medicine Database), and other resources [WHOITRP (Globe Health Organization International Trials Registry Platform search portal, http://www.who.int/trialsearch/), ATCR (Australian New Zealand Clinical Trials Registry, http://www.anzctr.org.au/), ISRCTN (International Standard Randomized Controlled Trial Number Register, http://world wide web.controlled-trials.com/), TC (Trials Central, www.trialscentral.org/), and CCTR (Chinese Clinical Trial Register, http://www.chictr.org.cn/)]. The following search strategy was used: ("polypropylene mesh" or "absorbable mesh" or "mesh" or "meshes") and ("herniorrhaphy" or "hernioplasty" or "inguinal hernia repair" or "laparoscopic transabdominal preperitoneal hernia repair" or "totally extra-peritoneal repair") and ("male infertility" or "fertility" or "azoospermia" or "sperm motility"). There were no language restrictions in this study.

Inclusion and exclusion criteria

Clinical studies (RCTs, cohort studies, example controlled trials, case serial, and case reports) were considered for this study. Review articles and messages to editors and unrelated papers were excluded. The written report subjects were limited to men. The following outcomes were considered: testicular volume, testicular resistivity index, serum FSH, serum testosterone, serum LH, semen volume, α-glucosidase (mU), sperm morphology, sperm assay (peak systolic velocity (PSV), terminate diastolic velocity (EDV), pulsatility index (PI), resistivity index (RI)), and sperm concentration.

Data extraction and quality evaluation

All studies meeting the inclusion and exclusion criteria were retrieved by screening abstracts (DZ and WC). Two reviewers (DZ, WC) independently extracted the following terms by a self-fabricated grade generated from data included in each report: first author's family proper noun, publish year, country, type of surgery, written report design, total number of patients, age, blazon of mesh, hernia side, outcomes, and the follow-up period. Whatever disagreements were resolved by joint discussion amongst reviewers, and the author was contacted if there was any missing data. The methodological quality of the included studies was assessed according to Jada scoring. The assess terms were: adequate sequence generation (0–ii points), resource allotment concealment (0–ii points), blinding (0–2 points), and follow-up/withdraw (0–2 points). For these assessments, ane to 3 points were considered low quality and iv to 7 points were deemed high quality. Methodological quality assessment was independently performed by 2 reviewers (DZ and WC) [xx, 21]. The Oxford Center for Show-based Medicine – Levels of Prove (http://www.cebm.internet/oxford-center-evidence-based-medicine-levels-evidence-march-2009/) (Level I to Level V, level I was considered high level of bear witness, level V was considered low level of evidence) was used to assess the level of the clinical trials.

Statistical analysis

At that place was insufficient information included in the RCTs to perform the meta-assay, so descriptive analysis was performed for these studies. The descriptive assay was used if in that location was high clinical or statistical heterogeneity, and the subgroup analysis was used for high and low quality included studies or unlike interventions. The sensitivity analysis was performed when heterogeneity comes from the different methodological qualities of the included trials. Case control trials, cohort studies, retrospective, or example reports were too investigated past descriptive analysis. The egger's exam and Begg'due south examination were not used to explore the possibility of publication bias due to bereft data included in the studies [22–26].

Results

Search strategy

A total of 234 studies were identified for screening via title and abstract according to our search strategy. Among them, 137 studies were excluded for the same cross-duplicated articles, animal studies, and unrelated literature. The remaining 97 potentially relevant studies were identified after screening by abstract, in which 68 studies were excluded because they were reviews, messages to the editor, diagnosis studies, and studies that did not focus on infertility. Consequently, the 29 clinical studies that met the inclusion criteria were included past total-text reading [27–48]. Among them, at that place were vii RCTs concerning mesh hernia repair and infertility [ten, 13, 28, 31, 35, 44, 45]. Figure1 displays the details of the search selection process.

Flow diagram of the search procedure and written report choice

Study characteristics

This comprehensive systemic review focused on studies and reports published between 2003 and 2022 that investigated testicular function, semen, or male infertility after hernia repair, and information technology included 29 studies for a full of 36,916 participants. There were 15 studies conducted in Europe, 11 studies in Asia, and iii in America. There were seven RCTs, eight case control studies, three cohort studies, three case series, four example reports, and 3 retrospective studies. The surgical operations included LAP (TAPP, TEP) and open (LHR). The main outcomes included: testicular volume, testicular resistivity index, serum FSH, serum testosterone, serum LH, semen volume, concentration, movement, α-glucosidase, morphology, summit systolic velocity, end diastolic velocity, pulsatility index, and obstructive azoospermia with a follow-up from six to 36 months. Tablei demonstrates the characteristics of the included trials [ix, 10, thirteen–19, 27–46].

Table ane

Baseline characteristics of the included studies in the systematic review

Study (Writer/Year) (Evidence level)	Country	Surgery	Design	Patients (n)	Mean age (years)	Mesh materials	Hernia side	Outcome mensurate	Follow-upwards (months)
Bansal 2022 (I-1b) [13]	India	TAPP/TEP	RCT	TAPP 80	TAPP twoscore.ix ± 12.3	NS	Unilateral Hernia Bilateral hernia	Testicular functions Sexual functions	3
				VS TEP fourscore	TEP 40 ± 12.five
Krnić 2022 (3-3b) [xiv]	Republic of croatia	Open	Example-control	Non-complicated hernia 57 VS Incarcerated hernia 64	Grouping I 57 (forty–81)	Bard® mesh	Right Hernia Left Hernia	Testicular blood flow	5
					Group II 64 (28–80)
Lal 2022 (III-3b) [xv]	India	TEP	Self Instance-command	28	42.4 (18–72)	Bard 3DMax™ mesh	unilateral hernia (sixteen right sided and 8 left sided, 21 indirect and 3 direct hernias) and 4 to have bilateral hernia (2 direct and 2 indirect).	Resistive alphabetize	3
Gvenetadze 2022 (Three-3b) [16]	Georgia	Open	Case control	Lichtenstein 66 Gvenetadze method 149	19–xl	mesh	Bilateral	Oligospermia, reduction of the quantitative sperm	1,6
Shkvarkovskiy 2022 (III-3b) [17]	Russian	Open	Case control	New method 61	xix–61	Polymeric mesh	Hernia	testicular arteries, testicular book, sex activity hormones level.	NS
				Lichtenstein 63
Yan 2022 (Four-4) [18]	China	Open	Retrospective study	142	24.0 ± 2.0	mesh	Unilateral	Infertility Sex role	3–36
Khodari 2022 (IV-4) [19]	French republic	Open	Retrospective written report	69	NS	polypropylene mesh	Bilateral (history of hernia repair)	Gamble of infertility	NS
Stula 2022 (II-2b) [27]	Croatia	TAPP/Open	Cohort study	TAPP 29	61(33–81)	Prolene mesh	Unilateral Bilateral	testicular blood menstruation (RI, PSV, EDV), ASA	v–vi
				Open 53
Peeters 2022 (I-1b) [28]	Belgium	TEP	RCT	Marlex ® 20	20–50	(Marlex ®) VyproII ® TiMesh ®	Unilateral 39 Bilateral xx	Semen analysis	36
				VyproII ® 20
				TiMesh ® xix
Schouten 2022 (protocol) [29]	Netherlands	TEP	Cohort study	21	xviii–sixty	Prolene	Bilateral inguinal hernias	testicular perfusion and volume, semen quantity and quality endocrinological status	6
Stula 2022 (2-2b) [30]	Croatia	TAPP/Open	Cohort	TAPP15 Open28	62(33–81)	Prolene mesh	Unilateral Bilateral	Testicular, capsular, intratesticular arterial flow dynamics	5
Singh 2022 (I-1b) [31]	India	TAPP, TEP/Open	RCT	LAP (TAPP, TEP)60 Open up 57	LAP 45.vii ± 14.vi	mesh	Unilateral Bilateral	Testicular functions (testicular volume, claret flow, hormones)	3
					Open up 45.4 ± 17.eight
Hallén 2022 (IV-4) [32]	Sweden	Open	retrospective	Open 34,267	23–62	mesh	Unilateral Bilaterally	Take chances for infertility	12
						No mesh
Skawran 2022 (III-3b) [33]	Germany	TEP	Case control	Light mesh group 21	xviii–sixty	Bard TM soft mesh Bard TM flat mesh	Bilateral	Testicular volume and perfusion, serum levels of sexual hormones, ejaculate volume, and number of spermatic cells.	3
				Heavy group 38
Hallén 2022 (Three-3b) [34]	Sweden	NS	Case control	With mesh 232	xviii–55	mesh/ without mesh	Bilateral(344)	Adventure for infertility	NS
				Without mesh 112
				Control general 202
Peeters 2022 (I-1b) [10]	Belgium	TEP	RCT	Marlex ® 20	xx–50	(Marlex ®) VyproII ®	Unilateral 39 Bilateral xx	Semen analysis, scrotal ultrasonography	12
				VyproII ® 20		TiMesh ®
				TiMesh ® xix
Sucullu 2022 (I-1b) [35]	Turkey	open	RCT	Lichtenstein 32	LG 22 (20–28)	Polypropylene mesh	Unilateral	Testicular volume, resistive alphabetize Testicular function	3
				Mesh plug 32	MPG 23 (twenty–30)
Kiladze 2009 (Iii-3b) [36]	Georgia	Open	Example control	Lichtenstein 56	44.viii	mesh	Bilateral	Principal sperm parameters	half-dozen
				Modified Lichtenstein 61
Chu 2009 (IV-iv) [37]	USA	Open	Example series	iv	NS	mesh	NS	Testicular atrophy	6
Ramadan 2009 (Three-3b) [38]	Turkey	Open	Case command	Indirect inguinal hernias 48	44.5 (30–73)	mesh	Unilateral direct inguinal hernia	testicular parenchyma, testicular arterial impedance, perfusion, venous flow	two
				Normal contralateral side 48
Yamaguchi 2008 [39] (5-5)	Japan	Open	Case report	1	30	Polypropylene mesh	Bilateral herniorrhaphy	Hormonal testing Semen analyses Testicular size	15
Brisinda 2008 (IV-4) [40]	Italia	Open	Case series	26	NS	mesh	Hernia tension free repair	testicular perfusion	9
Dohle 2006 (V-5) [41]	Netherlands	open	Example report	2	35	Polypropylene mesh	Unilateral Bilateral	Semen analysis	3
Langenbach 2006 (I-1b) [42]	Frg	TAPP	RCT	Monofile, heavy-weight, rigid mesh xxx Smooth, heavy-weight variant of polypropylene 30 Polyglactin/polypropylene compound mesh 30	35–75	Rigid mesh Polypropylene Polyglactin/polypropylene	Unilateral	Testicular volume	iii
Shin 2005 (Iv-iv) [ix]	USA	LAP/Open	Case series	12 LAP ii Open+ LAP	35.5 (28–42)	Polypropylene mesh	Unilateral Bilateral	Zaoospermia	6–36
Nagler 2005 (V-5) [43]	USA	Open	Case written report	1	45	Polypropylene mesh	Right and left herniorrhaphy	Fructose-positive azoospermia	72
Akbulut 2003 (I-1b) [44]	Turkey	TEP / LHR	RCT	LHR 13 TEP 13	TEP 46.seven ± 1.seven LHR 54.2 ± 2.6	Polypropylene mesh	Unilateral Bilateral	Testicular function and volume	12
Aydede 2003 (I-1b) [45]	Turkey	Open up	RCT	Posterior preperitoneal mesh repair 30 Anterior tension-free repair 30	22 > 60 38 < threescore	mesh	Unilateral	Testicular flow spermatogenesis	2.5
Yang 1997 (V-5) [46]	China	Open (when child)	Case study	3	30/31/l	No mesh	Unilateral Bilateral	Obstructive azoospermia	30 twelvemonth

TAP laparoscopic transabdominal preperitoneal hernia repair, TEP totally actress-peritoneal repair, LHR lichtenstein hernia repair, LAP laparoscopic hernia repair, Group I not-complicated hernia, Goup Two incarcerated hernia. NS not land

Quality assessment of the included studies

Table2 displays the methodological quality of these studies according to Jada scores. Of all of the RCTs, seven studies reported acceptable generation of the allocation sequence and 1 RCT provided unclear descriptions. Six trials reported resource allotment concealment [10, 13, 28, 35, 44, 45]. Blinding was not reported in whatsoever of the RCTs. Patients that were lost to follow-upwards or withdraw were reported in all studies. There were six studies that were considered loftier quality (five points) and one RCT was low quality (three points) according to Jada scores. The evidence of seven trials were level I_1b, two were level Two_2b, and all of the RCTS were loftier level evidence.

Tabular array 2

Quality assessment of RCTs studies (Jada Scores)

1–3 points considered as low quality; iv–vii points considered equally high quality

Descriptive analysis

At that place was loftier clinical heterogeneity amid the included studies, so the meta-assay was not used, and instead, the descriptive subgroup analysis was performed. The groups were divided into laparoscopic hernia repair groups and open hernia repair groups. Subgroups were divided into the following groups: mesh versus not-mesh, LAP versus Open up, TAPP versus TEP, and Marlex mesh versus Vypro mesh. The detailed information from the outcomes of the seven RCTs is shown in Table3.

Table 3

The detailed data from the outcomes of the seven RCTs

Study ID	Surgery	Full No. of patients		Result and data
		O	C
Bansal 2022 [thirteen]	TAPP VS TEP	fourscore	80	Testicular volume: pre-operative, TAPP xiii.1 ± 1.three, TEP xiii.1 ± 1.2; iii months, TAPP 13.ane ± one.3, TEP 13.2 ± 1.1, 6 months TAPP 13.0 ± one.3, TEP xiii.2 ± 1.0 Testicular resistivity index: pre-operative, TAPP 0.64 ± 0.06, TEP 0.61 ± 0.07; 3 months, TAPP 0.634 ± 0.06, TEP 0.6 ± 0.07, vi months TAPP 0.63 ± 0.06, TEP 0.half-dozen ± 0.07 Serum FSH: pre-operative, TAPP three.6 ± 0.8, TEP 3.4 ± 0.8; 3 months, TAPP 3.6 ± one.0, TEP 3.4 ± 0.8, half-dozen months TAPP 3.6 ± 0.8, TEP 3.4 ± 0.9 Serum testosterone: pre-operative, TAPP 4.2 ± 1,TEP four.0 ± 1.2; 3 months, TAPP 4.1 ± 0.9, TEP 4.0 ± 1.three, half dozen months TAPP 4.i ± 1.0, TEP 4.0 ± 1.2 Serum LH: TAPP vii.three ± ane.1,TEP vii.3 ± ane.7; three months, TAPP 7.iii ± 1.0, TEP 7.3 ± i.67, 6 months TAPP 7.4 ± ane.0, TEP 7.three ± i.6
Peeters 2022 [28]	Marlex® VS vyproII® Marlex® VS TiMesh®	12	15/10	3 twelvemonth follow-up: Semen volume (ml): Marlex® -0.07 (− 1.ane to 0.half-dozen), vyproII® -0.one(− 1.five to 0.ii), TiMesh®-0.2 (− 0.9 to i) Concentration (106 cells/ml): Marlex® -4.iv (− 16.1 to 0.5), vyproII® -5.five (− 30.viii to eighteen.8), TiMesh®-1.65 (− xxx.6 to 17.1) Motility (% progression): Marlex® -2.8 (− 18 to 4.3), vyproII® -8.5 (− 23 to viii.5), TiMesh®-8 (− 15 to − iv.five) a-glucosidase (mU): Marlex® 3.2 (− 15.5 to 6), vyproII® -5.5 (− 13.vii to 0.2), TiMesh® -1.4(− 8 to 1.75) morphology (% normal): Marlex® -2 (− sixteen to 2), vyproII® -2.8 (− 9 to 0), TiMesh® -3 (− 8.5 to 4)
Singh 2022 [29]	Lap VS Open	60	sixty	Testicular volume: pre-operative, Lap, 9.viii; Open 10.7; 3 month, Lap ix.3, Open 9.two Resistitive index: pre-operative, Lap 0.64, Open 0.68; 3 calendar month, Lap 0.58, Open 0.65 FSH: pre-operative, Lap v,Open 5.1, 3 calendar month, Lap 5.one, Open up 6.1 LH: pre-operative, Lap 4.iv,Open four.5, 3 month, Lap 4.9, Open v.4 Testosterone: pre-operative, Lap 5.7,Open v.two, 3 month, Lap five.5, Open 4.seven
Peeters 2022 [10]	Marlex® VS vyproII® Marlex® VS TiMesh®	twenty	20/19	i year follow-upwardly: Semen book (ml): Marlex® -0.05 (− 0.vii to 0.7), vyproII® -0.43 (− 1.iii to 0.iii), TiMesh®0.2 (− 0.8 to 0.9) Concentration (106 cells/ml): Marlex® -9.vi (− 35.five to 13), vyproII® -i.5 (− 21.5 to x), TiMesh®2.1 (ten.3 to 15.eight) Move (% progression): Marlex® -two.0 (− 2 to 10), vyproII® -9.5 (− xiii.three to − 1), TiMesh®-v.5 (− 17 to − two) a-glucosidase (mU): Marlex® -three.half-dozen (− 7.6 to 9.7), vyproII® -one (− 3.7 to 3.7), TiMesh® 0(− 6.five to ane.8) morphology (% normal): Marlex® 0 (− 4.3 to five.viii), vyproII® -1.8 (0 to − 5), TiMesh® -i.viii (− 6.8 to 5)
Sucullu 2022 [35]	LG VS MPG	32	32	Testicular volume: pre-operative, LG, xviii.92 ± 1.05; MPG, xix.37 ± 1.06 3 months, LG eighteen.75 ± 1.26, MPG xviii.21 ± one.26 Resistive index: pre-operative,LG,0.64 ± 0.06, MPG 0.60 ± 0.04; iii months, LG 0.80 ± 0.06, MPG 0.75 ± 0.08 Sperm concentration: pre-operative, LG,88.65 ± ten.xxx, MPG 75.27 ± seven.03; three months, LG 65.48 ± 8.22 MPG 58.87 ± 7.73 Charge per unit of progressive movement: pre-operative, LG 52.79 ± ii.35, MPG 51.64 ± 2.lx 3 months, LG 55.54 ± 2.26, MPG 48.53 ± 2.96
Akbulut 2003 [44]	TEP VS LHR	thirteen	xiii	three-calendar month. Testicular volume: pre-operative, TEP, 16.33 ± 0.71; LHR 15.44 ± 0.87; 3 month, TEP 16.lxx ± 0.88, LHR 14.15 ± 0.96 FSH: pre-operative, TEP 6.47 ± 0.63, LHR 8.47 ± 1.11, 3 month, TEP 6.99 ± 0.86, LHR ix.12 ± 1.57 LH: pre-operative, TEP iv.06 ± 0.twoscore, LHR 5.35 ± 0.57, 3 month, TEP four.72 ± 0.seventy, LHR v.64 ± 0.72 Testosterone: pre-operative, TEP 631.75 ± 60.52, LHR 544.48 ± 36.26, 3 calendar month, TEP 672.00 ± 62.99, LHR 510.64 ± 39.71
Aydede 2003 [45]	TFR VS PPMR	xxx	30	peak systolic velocity (PSV):pre-operative TFR xi.1303 ± 0.6952, PPMR 10.25.20 ± 0.5033; 2.v months, TFR 10.8400 ± 0.7084 PPMR 10.4890 ± 0.5194 end diastolic velocity (EDV): pre-operative TFR 3.1257 ± 0.1995, PPMR three.0287 ± 0.5648; two.5 months, TFR 1.4267 ± 6.544 PPMR 1.2957 ± 8.842 pulsatility index (PI): pre-operative TFR one.3753 ± 9.177,PPMR 1.3460 ± 0.1082; 2.v months,TFR 0.7193 ± i.294 PPMR 0.6930 ± 1.887 resistivity index (RI): pre-operative TFR 0.6960 ± two.192, PPMR 0.6867 ± ii.267; 2.5 months, TFR 2.8400 ± 0.1973 PPMR three.0163 ± 0.1880

O observation grouping, C control group, LG Lichtenstein group, MPG Mesh plug group, TFR Inductive tension-free repair, PPMR Posterior preperitoneal mesh repair

Laparoscopic mesh hernia repair group

There were 12 studies for a total of 1230 patients included in this group. The baseline characteristics are shown in Tabular array ​ 1.

Sub-analysis

LAP (TAPP/TEP) versus open up group

In the Singh 2022 study (Level I_1b), there were a full of 117 patients with a mean historic period of 45.vi ± 16.two years (range 17–79). In Grouping I, 32 patients underwent TEP and 28 underwent TAPP. Grouping Two had 57 patients that underwent open mesh repair. The follow-upwardly time was preoperatively and postoperatively set at 3 months. There was no meaning deviation between those 2 groups in testicular functions, preoperatively. In that location were statistically significant decreases in the testicular volume, preoperatively and postoperatively in the open grouping (P = 0.01), but there was no significant difference, preoperatively and postoperatively in the LAP grouping (P = 0.3). There was as well statistical significance in the resistive index, preoperatively and postoperatively in the open up group (P = 0.07) and the LAP grouping (P = 0.04). In the LAP group, in that location was no pregnant departure in FSH levels (P = 0.4) and testosterone (P = 0.3) betwixt preoperatively and postoperatively; still the decrease was significant in LH levels (P = 0.01) after operation. In the open group, in that location was statistical significance in FSH (P = 0.01), LH (P = 0.001), and testosterone (P = 0.02) between preoperatively and postoperatively. This trial suggested that laparoscopic repair may be more suitable for preserving testicular functions [31]. In the Akbulut 2003 study (level I_1b); at that place were a total of threescore patients with the age of fifty.5 ± 4.4 (range 24–71). The follow-upward time was 3 months. 26 patients were randomized and divided into the TEP grouping (13 patients) and Lichtenstein hernia repair (LHR) group (13 patients). At that place were no significant differences between preoperative and postoperative in both groups in regards to LH (P > 0.05) and FSH levels (P > 0.05). Withal, the subtract was significantly different in the testicular book and testosterone levels in the TEP grouping (P < 0.05) compared to the LHR group (P > 0.05). It was indicated that the procedures would not alter LH, FSH, or testosterone values, but TEP could lead to a reduction in testicular volume within the normal limits [46]. Schouten 2022 designed a protocol for accomplice studies in order to evaluate fertility after endoscopic TEP hernia repair, but no data has been published [29]. In Stula 2022 (II_2b), there were a total of 543 patients with a mean age of 61 years (ranging 33–81). The follow-up time ranged from 5 to 6 months. There were 29 patients who underwent TAPP and 53 patients under open tension-free hernia repair. There was no significant deviation between the 2 groups in baseline. The anti-sperm antibodies (ASA) value significantly increased in the open grouping after operation (P < 0.001), simply at that place was no significant divergence in the TAPP group (P = 0.133). There was pregnant change in the resistive index (P < 0.001) and capsular artery level (P = 0.02) of the resistive alphabetize (RI), in patients who underwent TAPP. End-diastolic velocity (EDV) showed meaning differences on the testicular artery level (P = 0.032) in patients in the open group. This report showed that mesh hernia repairs, open up or laparoscopically, caused only a transitory change in testicular claret menstruum, but there was no clinical meaning departure [27]. In the Stula 2022 study (level Two_2b), there were a full of 43 patients with 62 years (range 33-81 years). The follow-upward fourth dimension was 5 months. There were 15 who underwent the TAPP procedure and 28 in the open (open up tension-free hernia repair). This trial indicated that inguinal hernia mesh repairs exercise non accept a clinical significant influence on testicular flow and sperm autoimmunity [30].

TAPP versus TEP group

In Bansal 2022 (level I_1b), the RCT was divided into the TAPP group with 80 patients and TEP group with 80 patients. The mean age was twoscore.v ± 12.4 (rang 18–60). The follow-upwards time was 3 months and 6 months. In that location was no significant difference in testicular volume (P > 0.05), testicular resistivity index (P > 0.05), FSH (P > 0.05), testosterone level (P > 0.05), and LH (P > 0.05) between the ii groups at the 3 month or 6 month follow-up [13].

Different meshes comparable groups

In Peters' 2022 report (level I_1b), there were a total of 59 patients with an age range of 20–50 years. The patients were randomized into 3 groups: heavyweight polypropylene (Marlex®) with 20 patients, lightweight mesh (VyproII®) with twenty patients, and lightweight mesh (TiMesh®) with 19 patients, and all of the patients underwent TEP. The follow-up was at one year. This written report suggests that the use of lightweight meshes for male patients with TEP could influence sperm motion (P = 0.013) at the i year follow-upwards [35]. In Peeters' 2022 study (level I_1b), he utilized the same patients as Peters' 2022, simply the follow-upwardly time was increased to 3 years. There was decreased sperm move after one year, merely there was no pregnant departure amidst the 3 groups in semen volume (P > 0.05), concentration (P > 0.05), move (P > 0.05), a-glucosidase (P > 0.05) and morphology (P > 0.05) after 3 years. In Langenbach's 2006 study (evidence, level V), he mentioned a change in testicular book, simply there were no detailed data supporting the ascertainment [28].

LAP group without controls

In this group, there were ii studies: Lal 2022 (level Three_3b) and Skawran 2022 (level III_3b). In the Lal 2022 written report, in that location were a total of 28 patients: 24 with unilateral hernia, 4 with bilateral hernia who underwent TEP. The mean age was 42.iv years (range 18–72). The resistive index was followed-upwardly at 24 h, one week, and 3 months and compared preoperatively confronting postoperatively. In that location was no significant difference in resistive indexes of testicular, capsular, and intratesticular arteries during any fourth dimension postoperatively [xv]. In the Skawran 2022 study, there were a total of 59 patients with an age range of 18–threescore years who underwent a bilateral TEP repairs. In the prospectively (light mesh) group, in that location were 21 patients, the preoperative values were compared with postoperative values, and the follow-upwards time was 3 months. It showed that at that place were no statistical differences between preoperative and postoperative in testicular book, testicular perfusion, FSH, LH, testosterone, and testicular function (ejaculate book) (P > 0.05). There were 38 patients in the retrospective (heavy mesh) group where the follow-upwards was determined at ≥iii months. Again, there was no significant difference between the prospective group and retrospective group in testicular volume, testicular perfusion, FSH, LH, and ejaculate volume (P > 0.05) [33].

Open mesh hernia repair group

Subgroup analysis

Compare with different hernia repair methods

In the Gvenetadze 2022 report (level III_3b), there were a total of 215 patients with an age range from 19 to 40 years. 66 underwent bilateral Lichtenstein hernia repair and 149 underwent the bilateral Gvenetadze method (a modified Lichtenstein with spermatic cord isolation from a mesh by Gvenetadze. The follow-up times were set at 2 days prior to the operation, 30 days, and 6 months mail service operation. They constitute oligospermia and a 30–35% reduction of the quantitative sperm in the Lichtenstein group (P < 0.01). However, there was no significant difference in the Gvenetadze grouping [xvi]. In Shkvarkovskiy 2022 study (level III_3b), in that location were a total of 124 patients with an age range from 19 to 61. 61 had their procedure with the new method (patent of Ukraine for useful model № 81,728) and 63 underwent the Lichtenstein hernia repair. The outcomes were testicular arteries, testicular volume, and the level of sex hormones. This study was published in Russian and supplied no detailed information [17]. Nosotros emailed the author but at that place was no response. In Sucullu'due south 2022 study (level I_1b), there were a total of 64 unilateral patients with an historic period range from xx to 30 years. There were 32 patients in the Lichtenstein group and 32 underwent the mesh plug surgery. The follow-up fourth dimension was 3 months. There was a significant increase in the RI in both the Lichtenstein grouping (P = 0.027) and the mesh plug group (P = 0.012), when comparing the preoperative with the postoperative values [35]. In Kiladze'due south 2009 written report (level III_3b), at that place were a total of 117 bilateral patients with an average age of 44.8 years. The follow-up time was 6 months. 56 patients were in the Lichtenstein group and 117 were with the Gvenetadze group. Comparing the morphological parameters of sperm between the pre- and postoperative mesh hernia repair in these ii groups, the results showed that complete isolation of the spermatic string from the mesh prevents male infertility later on a modified Lichtenstein hernioplast [36]. In Aydede'southward 2003 study (level I_1b), there were a total of threescore patients with 20 patients > 60 years one-time and 38 patients < 60 years old. 30 patients with posterior preperitoneal mesh repair (group I) with xxx patients were compared against the anterior tension-free repair (grouping II) with 30 patients. The follow-upwards time was pre-operative, early on postoperative (the tertiary 24-hour interval), and tardily postoperative (half-dozen months). The results showed that in that location were meaning differences betwixt preoperative and early on postoperative in Doppler menses parameters (spermatic cord and peak systolic velocity(PSV), stop diastolic velocity(EDV), and resistivity index (RI)) (all P < 0.05). In that location was no meaning difference between preoperative and late postoperative values in Doppler catamenia parameters [45].

Compare with different hernias

In Krnic's 2022 report (level Iii_3b), there were a full of 121 patients with an age range of 28–81 years. Group I had 57 patients with not-complicated hernia, and Group II had 64 patients with incarcerated hernia. Bard Mesh was used, and the follow-up time was five months. Resistive index, pulsative alphabetize, and antisperm temporarily fluctuated after the operation, only they returned to or were within normal values during the belatedly postoperative phase in both groups. This study suggested that polypropylene mesh did not lead to whatever clinically meaning complications on testicular flow in patients nether open hernia repair with either not-complicated or incarcerated hernia [fourteen]. In Ramadan's 2009 study (level Three_3b), there were a total of 48 patients with indirect inguinal hernia, and the mean historic period was 44.five years (range, 30–73 years). The contralateral non-hernia side was prepare as the control group. Testicular arterial impedance, venous plexus flow, and testicular perfusion were assessed pre-and postoperatively on both sides, and the follow-upwardly time was 2 months. The results showed that there were no significant changes regarding testicular flow (P > 0.05) [38].

Compare with unlike meshes or no mesh

In Hallen's 2022 study (level IV₄), from 1992 to 2007, 34,267 men with an age range of 28 to l years, underwent an inguinal hernia repair involving at to the lowest degree one side. Information technology was found that 57 of the 6281 men who underwent the unilaterally without mesh procedure were diagnosed with infertility. The observed cumulative incidence was 95% CI 0.91 (0.49–0.69) whereas the expected cumulative incidence was i.03. There were 133 out of 22,420 men who underwent the unilaterally with mesh procedure that were diagnosed with infertility. The 95% CI of observed cumulative incidence was 0.59 (0.49 to 0.69), and the expected cumulative incidence was 0.67. In the operated bilaterally without mesh group, the infertility incidence was 0/226 where the expected cumulative incidence was 1.01. In operated bilaterally with mesh unilaterally grouping, the infertility incidence was 3/346, 95% CI of observed cumulative incidence was 0.87 (0 to 18.4), and the expected cumulative incidence was 1.05. In operated bilaterally with mesh on both sides, the infertility incidence was 19/2293, 95% CI 0.83 (0.46–1.20), and the expected cumulative incidence was 0.64, and in repeated repairs on any side, the values were 21/2701, 95% (0.45–1.11), and 0.68. The incidence of infertility had no pregnant change for either the mesh groups or the no-mesh groups. For most groups, the expected cumulative incidence was lower than the general population [32]. In Hallen's 2022 study (level III_3b), the study was based on information from the Swedish Hernia Annals and questionnaire. In that location were a total of 525 participants analyzed. There were 232 in the bilateral mesh repair group with the hateful age of 42.3 ± 8.viii years, 112 in the non-mesh group with 43.4 ± 8.eight years, and 181 in the normal population with 43.1 ± 8.one years. At that place was no substantial event in testicular status co-ordinate to the questionnaire [34].

Open hernia repair

In this grouping, these studies were either retrospective, case serial, or case reports.

Yan et al. (level IV₄) performed retrospective analysis for 142 young men under Lichtenstein, and the follow-up time was three to 36 months. There was no infertility found [18]. Khodari et al. (level 4_four) reported that there were 69 azoospermia patients with a history of adult inguinal hernia repair surgery from 1990 to 2022, just there was no detailed report provided in the analysis [xix]. Chu et al. examined iv cases under the inguinal hernia mesh repair with the results showing that testicular ischemia of 2/iv patients was inverse, caused by either the mesh loosening or being removed [37]. Yamaguchi et al. (level V₅) reported that a 30 twelvemonth old human being had vas deferens obstruction later inguinal hernia repair with polypropylene mesh inside several months [39]. Before azoospermia, men who underwent inguinal herniorrhaphy using polypropylene mesh needed to rapidly cryopreserve their sperm for future fertility; however Testicular / Epididymal Sperm Aspiration or Extraction (TESE-ICSI) was also a suitable treatment. Brisinda et al. (level IV₄) prospectively analyzed 24 patients under open tension-free hernia repair with synthetic meshes in 2008 [forty]. At that place were no statistically meaning differences found in the testicular blood flow parameters and testicular volume comparing preoperative with postoperative. In fact, testicular menses improved in some cases. Dohle et al. (level 5₅) reported two cases of obstructive male infertility due to vassal obstruction later on hernia repair with polypropylene mesh. It was believed that polypropylene mesh caused a dense fibroblastic reaction; thus affecting the vas deferens and spermatic string [41]. Nagler et al. (level 5_five) reported a 45 year old man experienced obstructive azoospermia after polypropylene mesh repair and a left varicocelectomy. They thought that this effect was influenced past the mesh resulting in fibrosis of the vas deferens [43].

Publication bias

Although there were seven RCTs in our study, there was no sufficient information included in the studies so the funnel plot, the egger'south test and Begg's examination were not explored.

Discussion

Laparoscopic mesh hernia repair group

LAP (included TAPP/TEP) versus open up grouping

Singh et al. reported that there were significant decreases in testosterone, LH, and FSH with less growth in testicular volume under the laparoscopic group; notwithstanding there was no significant deviation in testicular atrophy in either the open repair with polypropylene mesh (heavyweight) or the laparoscopic inguinal hernia repair with polypropylene mesh groups [31]. Akbulut et al. reported that there was no pregnant deviation in the TEP group or the Lichtenstein group in FSH, LH, testosterone, and testicular book, but TEP may take decreased testicular book post-functioning to the normal limits with type I-b, 2-a [44]. The diverse results with Singh et al. may have been caused by the small sample size, type of hernia, or maybe human error. For case, some TAPP procedures might take been mistakenly placed in the laparoscopic group. Stula et al. reported that mesh hernia repairs under open up tension-complimentary hernia repair or TAPP were only changed in the resistive alphabetize, end diastolic velocity, and peak systolic velocity in the early postoperative period but returned to a normal value, which they believe has no clinical significance. However, they did not compare the heavyweight against the low-cal heavyweight; instead they only mentioned that the heavyweight mesh was used in the open hernia repair group. The age range included was from 17 to 81 years old, so the normal fluctuations might exist related with age [27]. This consequence was similar to an earlier report published by Stula et al., in 2022 [30]. Overall, inguinal hernia mesh repair under open tension-free hernia repair or TAPP did not have clinical significance on testicular flow and immunological response. Thus, these results from the studies indicate that polypropylene mesh LAP inguinal repair did not alter male infertility during either procedure.

TAPP versus TEP group

Bansal et al. suggested that there was no alter in testicular and sexual function after TAPP compared with TEP. According to the publication, changes in male infertility have no relation to the techniques used for TAPP or TEP; however they did not mention mesh in the procedures. Rather, the authors thought that handling the testicular vessels and string structures during autopsy may change the etiology of testicular dysfunction after open mesh repair [thirteen].

Different meshes groups

Peeters et al. indicated that VyproII® or TiMesh® (lightweight mesh) decreased sperm motility when compared to Marlex® mesh (heavyweight) afterwards a i year follow-up, but at that place was no significant difference after three years. In dissimilarity, the lightweight mesh groups had a lower recurrence rate and no chronic pain, so lightweight mesh could be the superior selection [28, 35]. Junge et al. suggested that using modern depression weight, large, porous, and rubberband samples could have a benefit on the integrity of the vas deferens, when mesh is the required material to be used in younger patients undergoing open up hernia repair [47].

LAP grouping, no control group

Lal et al. indicated that laparoscopic TEP operations practice not modify testicular period dynamics at 24 h, 1 calendar week, or iii months postoperative [fifteen]. Skawarn et al. suggested that there was no bear witness of impaired fertility after TEP operation with calorie-free or heavy mesh [33]. In that location was no case study found regarding infertility caused by the LAP procedure. The reason behind this is that the LAP procedure allows for less damage and stress to the spermatic string.

Open mesh hernia repair group

Compare with different hernia repair methods

Gvenetadze et al. indicated that the Gvenetadze method was meliorate than Lichtenstein's in preventing male infertility when undergoing open surgery [16]. Kiladze et al. suggested that the Gvenetadze method prevented male infertility though spermatic string isolation from mesh in bilateral hernia procedures compared to the Lichtenstein hernia repair [37]. Contrarily, Sucullu et al. and Aydede et al. indicated that whether the Lichtenstein, mesh plug method, posterior pre-peritoneal mesh repair, or anterior tension-free repair were used, none of the procedures caused infertility. Thus, it seems that numerous hernia repair methods which are performed routinely in the clinic do not lead to infertility [35, 42, 45].

Compare different hernias

Krnic et al. reported that 57 patients had non-complicated hernia procedures whereas 64 patients with incarcerated hernia. Bard Mesh was used in both groups. This report suggested that polypropylene mesh did not atomic number 82 to whatsoever clinically significant problems on testicular flow in patients undergoing open hernia repair with either non-complicated or incarcerated hernia [14]. In the Ramadan et al. study, it showed that there was no pregnant modify to testicular flow in the hernia side vs. non-hernia side; thus, dissimilar types of hernias may not impact infertility under the open up hernia repair with mesh [38].

Compare with meshes with no mesh

Hallen et al. performed an epidemiological survey in 2022, 232 in the bilateral mesh repair group and 112 in the not-mesh group were analyzed. In that location were no noteworthy furnishings in the testicular status of either grouping, co-ordinate to the questionnaire. The authors believed that local legal circumstances and wellness care policies should be taken into consideration when doing sperm cryopreservation and the health care system should cover the cost of this fee if immature men wish to have children later on in life [34]. The following yr, Hallen et al. started a larger epidemiological survey where 0.ix% (57/6281) of men were diagnosed with infertility after existence operated on unilaterally without mesh compared to 0.59% (133/22420) of men with mesh. In the operated bilaterally, mesh on one side group, the infertility incidence was 0.87% (iii/346). In operated bilaterally, mesh on both sides group, the incidence was 0.83% (xix/2293) and in repeated repairs on any side, at that place was 0.77% (21/2701). The results showed that the incidence of infertility had no consequence in either the mesh groups with no-mesh groups, and mesh repair may continue to be used without major business concern regarding the risk of male infertility [32].

Open hernia repair

In this group, these studies were retrospectives, case serial, or case reports. Yan et al. and Brisinda et al. reported that there was no evidence that indicated that infertility was caused by the Lichtenstein or open tension-free hernia procedure [18, 40]. Khodari et al. mentioned that there were 69 azoospermia patients with a history of undergoing adult inguinal hernia repair surgery only did not draw the causes for the azoospermia [19]. Nagler et al. considered that a case with azoospermia was caused by mesh due to fibrosis of the vas deferens [43]. Yamaguchi et al. and Dohle et al. reported three cases with vas deferens obstruction after inguinal hernia repair with polypropylene mesh [39, 41]. Uzzo et al. reported in a 12 male beagle canis familiaris animal trial where half of the dogs were repaired using Marlex mesh and one-half had the classic Shouldice technique. At that place was a significant decrease in vasal luminal size with a marked soft tissue foreign body reaction identified in the Marlex mesh grouping [48].

Why could this change in procedure atomic number 82 to infertility? There may exist a relationship with mesh migration, surgeon skills, tightness of intraoperative suture or the surrounding tissue was non completely separated. The resulting postoperative bleeding, adhesions, and postoperative practice frictions then trigger fibrosis which can lead to infertility. Chu et al. (level IV₄) reported two cases of testicular ischemia that were altered under inguinal hernia mesh repair, caused by the mesh loosening or removal [37]. Although at that place are fewer reports on vas deferens blockage, we nonetheless should focus on the standardization for operative procedures in order to lessen and ultimately, eliminate postoperative complications from the treatment. Some other reason backside the cause of these medical concerns could exist due to the level of the surgeon'south skill. For example, if the blood vessels were damaged during the intraoperative performance, it would pb to vas deferens ischemia, which could cause infertility. Some cases that are diagnosed as infertility may be associated instead with the inguinal hernia. Singh et al. indicated that long term inguinal hernia patients might suffer from impairment in testicular blood flow, which could likewise lead to infertility [31]. Additional factors that could impact infertility could include the patient's age, piece of work status, psychological factors, and the environs. Previously, our beast studies suggested that the distribution of inguinal hernia may be related to estrogen levels, and these estrogen levels may be associated with infertility. Aydede et al. suggested that mesh repair is still a rubber surgery in patients with no children or those who are currently undergoing infertility treatment [45]; just in our opinion, if a fellow desires to have children in the time to come and is apprehensive about potential issues to his fertility due to the surgical procedure, he should accept his semen examined and stored preoperatively to avoid hereafter issues and medical disputes.

The major limitations of our study were the post-obit: 1) there was high clinical heterogeneity between the included RCTs, 2) at that place were pocket-size samples for these included studies, and 3) the period of treatment for each written report and mesh were different. For some of these studies, at that place was insufficient information provided for meta-analysis, and the evidence was weak, so funnel plot and meta-assay were not performed. That will atomic number 82 to some publication bias and less strong show. Larger samples, rigorous design, multi-centre RCTs performed using diverse populations, and different mesh/intervention groups would exist necessary to heighten this evidence and support a stronger conclusion regarding infertility in these procedures.

Decision

The results of our review suggest that open or laparoscopic procedures with mesh hernia repair have no significant effects on male infertility according to the current RCTs and clinical trials (Evidence: level I). Overall, laparoscopic mesh repair might be more suitable to use for preserving testicular functions; still our main focus should exist on standardizing operative procedures in gild to lessen or eliminate postoperative complications.

Acknowledgments

Nosotros give thanks Dr. Soper for helping to review and providing communication in regards to the manuscript.

Abbreviations

ASA	Anti-sperm antibodies
ATCR	Australian New Zealand Clinical Trials Registry
CBM	Chinese biomedical medicine database
CCTR	Chinese clinical trial register
Central	Cochrane Library hosts the Cardinal Register of Controlled Trials
EDV	End diastolic velocity
EDV	Terminate-diastolic velocity
FSH	Follicle-stimulating hormone
ISRCTN	International Standard Randomized Controlled Trial Number Annals
LH	Luteinizing hormone
LHR	Lichtenstein hernia repair
mU	α-glucosidase
PI	Pulsatility index
PSV	Peak systolic velocity
RCT	Randomized controlled trials
RI	Resistivity index
TAPP	laparoscopic transabdominal preperitoneal hernia repair
TC	Trials Central
TEP	Totally extra-peritoneal repair
TESE-ICSI	Testicular / Epididymal Sperm Aspiration or Extraction
WHOITRP	World Wellness System International Trials Registry Platform search portal

Authors' contributions

ZH and CW designed and reviewed the study. ZD, SK and CW nerveless data, conducted analysis and wrote the manuscript. All authors read and approved the final manuscript.

Notes

Ideals approval and consent to participate

Not applicative. This article is a systematic review and descriptive analysis, so no ethical board blessing is needed.

Competing interests

The authors declare that they have no competing interests.

Publisher'southward Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Data

Cunchuan Wang, Phone: +86 20 38688608, Email: moc.361@5102ccwt.

Hong Zhao, Phone: 312-503-0780, Email: ude.nretsewhtron@oahz-h.

References

1. Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg. 1989;157(2):188–193. doi: ten.1016/0002-9610(89)90526-6. [PubMed] [CrossRef] [Google Scholar]

2. Zulu HG, Mewa Kinoo Southward, Singh B. Comparison of Lichtenstein inguinal hernia repair with the tension-gratis Desarda technique: a clinical audit and review of the literature. Trop Dr. 2016;46(3):125–129. [PubMed] [Google Scholar]

iii. Wei FX, Zhang YC, Han W, Zhang YL, Shao Y, Ni R. Transabdominal Preperitoneal (TAPP) versus totally Extraperitoneal (TEP) for LaparoscopicHernia repair: a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2015;25(v):375–383. doi: ten.1097/SLE.0000000000000123. [PubMed] [CrossRef] [Google Scholar]

4. Bilsel Y, Abci I. The search for ideal hernia repair; mesh materials and types. Int J Surg. 2012;10(half-dozen):317–321. doi: x.1016/j.ijsu.2012.05.002. [PubMed] [CrossRef] [Google Scholar]

5. Heikkinen T, Wollert S, Osterberg J, Bringman South. Early results of a randomised trial comparing Prolene and VyproII-mesh in endoscopic extraperitoneal inguinal hernia repair (TEP) of recurrent unilateral hernias. Hernia. 2006;10(1):34–xl. doi: 10.1007/s10029-005-0026-6. [PubMed] [CrossRef] [Google Scholar]

six. Robinson TN, Clarke JH, Schoen J, Walsh MD. Major mesh-related complications following hernia repair: events reported to the Nutrient and Drug Assistants. Surg Endosc. 2005;19(12):1556–1560. doi: 10.1007/s00464-005-0120-y. [PubMed] [CrossRef] [Google Scholar]

7. Köckerling F, Bittner R, Jacob DA, Seidelmann Fifty, Keller T, Adolf D, Kraft B, Kuthe A. TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a chief unilateral inguinal hernia. Surg Endosc. 2015;29(12):3750–3760. doi: 10.1007/s00464-015-4150-nine. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

viii. Protasov AV, Krivtsov GA, Mikhaleva LM, Tabuĭka AV, Shukhtin NI. Effects of inguinal hernioplasty mesh implant on reproductive role. Khirurgiia (Mosk) 2010;viii:28–32. [PubMed] [Google Scholar]

nine. Shin D, Lipshultz LI, Goldstein M, Barmé GA, Fuchs EF, Nagler HM, McCallum SW, Niederberger CS, Schoor RA, Brugh VM, 3rd, Honig SC. Herniorrhaphy with polypropylene mesh causing inguinal vasal obstacle: a preventable cause of obstructive azoospermia. Ann Surg. 2005;241(iv):553–558. doi: x.1097/01.sla.0000157318.13975.2a. [PMC complimentary article] [PubMed] [CrossRef] [Google Scholar]

10. Peeters E, Spiessens C, Oyen R, De Wever L, Vanderschueren D, Penninckx F, Miserez M. Laparoscopic inguinal hernia repair in men with lightweight meshes may significantly impair sperm motility: a randomized controlled trial. Ann Surg. 2010;252(2):240–246. doi: 10.1097/SLA.0b013e3181e8fac5. [PubMed] [CrossRef] [Google Scholar]

11. Tekatli H, Schouten N, van Dalen T, Burgmans I, Smakman North. Mechanism, assessment, and incidence of male infertility afterward inguinal hernia surgery: a review of the preclinical and clinical literature. Am J Surg. 2012;204(4):503–509. doi: 10.1016/j.amjsurg.2012.03.002. [PubMed] [CrossRef] [Google Scholar]

12. Kordzadeh A, Liu MO, Jayanthi NV. Male infertility following inguinal hernia repair: a systematic review and pooled analysis. Hernia. 2017;21(i):1–7. doi: 10.1007/s10029-016-1560-0. [PubMed] [CrossRef] [Google Scholar]

13. Bansal VK, Krishna A, Manek P, Kumar S, Prajapati O, Subramaniam R, Kumar A, Kumar A, Sagar R, Misra MC. A prospective randomized comparison of testicular functions, sexual functions and quality of life following laparoscopic totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) inguinal hernia repairs. Surg Endosc. 2017;31(iii):1478–1486. doi: 10.1007/s00464-016-5142-0. [PubMed] [CrossRef] [Google Scholar]

14. Krnić D, Družijanić N, Štula I, Čapkun V, Krnić D. Incarcerated inguinal hernia mesh repair: consequence on testicular blood catamenia and sperm autoimmunity. Med Sci Monit. 2016;22:1524–1533. doi: 10.12659/MSM.898727. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

fifteen. Lal P, Bansal B, Sharma R, Pradhan Grand. Laparoscopic TEP repair of inguinal hernia does not alter testicular perfusion. Hernia. 2016;xx(3):429–434. doi: 10.1007/s10029-016-1479-5. [PubMed] [CrossRef] [Google Scholar]

16. Gvenetadze T. Prevention of male infertility development subsequently Lichtenstein method. Hernia. 2016;xx(1 SUPPL.1):S72. [Google Scholar]

17. Shkvarkovskiy Iv, Moskaliuk OP, Grebeniuk Half-dozen, Yakobchuk SA, Rusak OB. Clinical use of a new method of inguinal hernia repair. Georgian Med News. 2015;239:vii–10. [PubMed] [Google Scholar]

18. Yan L, Zhang P, Lu Z, Luo B, Xu P. Characteristics assay and procedure choice of inguinal hernia in young male: a report of 142 cases. Chinese J Hernia Intestinal Wall Surgery (Electronic Version) 2015;9(half-dozen):23–24. [Google Scholar]

19. Khodari M, Ouzzane A, Marcelli F, Yakoubi R, Mitchell V, Zerbib P, Rigot JM. Azoospermia and a history of inguinal hernia repair in developed. Prog Urol. 2015;25(12):692–697. doi: ten.1016/j.purol.2015.06.008. [PubMed] [CrossRef] [Google Scholar]

twenty. JPT H, Greenish S, editors. Cochrane handbook for systematic reviews of interventions version five.1.0 [updated march 2022]. The Cochrane collaboration. 2022. [Google Scholar]

21. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials. 1996;17:1–12. doi: ten.1016/0197-2456(95)00134-iv. [PubMed] [CrossRef] [Google Scholar]

23. Thabane L, Mbuagbaw Fifty, Zhang Southward, Samaan Z, Marcucci M, Ye C, Thabane M, Giangregorio L, Dennis B, Kosa D, Borg Debono V, Dillenburg R, Fruci Five, Bawor M, Lee J, Wells M, Goldsmith CH. A tutorial on sensitivity analyses in clinical trials: the what, why, when and how. BMC Med Res Methodol. 2013;13:92. doi: 10.1186/1471-2288-13-92. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

24. Bowden J, Tierney JF, Copas AJ, Burdett S. Quantifying, displaying and accounting for heterogeneity in the meta-assay of RCTs using standard and generalised Q statistics. BMC Med Res Methodol. 2011;xi:41. doi: x.1186/1471-2288-11-41. [PMC gratis article] [PubMed] [CrossRef] [Google Scholar]

25. Begg CB, Mazumdar Thousand. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;fifty(4):1088–1101. doi: 10.2307/2533446. [PubMed] [CrossRef] [Google Scholar]

26. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. British Med J. 1997;315(7109):629–634. doi: x.1136/bmj.315.7109.629. [PMC costless commodity] [PubMed] [CrossRef] [Google Scholar]

27. Štula I, Družijanić N, Sapunar A, Perko Z, Bošnjak N, Kraljević D. Antisperm antibodies and testicular blood period after inguinal hernia mesh repair. Surg Endosc. 2014;28(12):3413–3420. doi: 10.1007/s00464-014-3614-7. [PubMed] [CrossRef] [Google Scholar]

28. Peeters E, Spiessens C, Oyen R, De Wever 50, Vanderschueren D, Penninckx F, Miserez Thou. Sperm motility afterward laparoscopic inguinal hernia repair with lightweight meshes: 3-year follow-upwardly of a randomised clinical trial. Hernia. 2014;eighteen(three):361–367. [PubMed] [Google Scholar]

29. Schouten N, van Dalen T, Smakman Northward, Elias SG, van de H2o C, Spermon RJ, Mulder LS, Burgmans IP. Male infertility later endoscopic totally Extraperitoneal (Tep) hernia repair (main): rationale and design of a prospective observational cohort study. BMC Surg. 2012;12:7. doi: 10.1186/1471-2482-12-7. [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]

thirty. Stula I, Družijanić N, Sršen D, Capkun V, Perko Z, Sapunar A, Kraljević D, Bošnjak N, Pogorelić Z. Influence of inguinal hernia mesh repair on testicular period and sperm autoimmunity. Hernia. 2012;16(iv):417–424. doi: 10.1007/s10029-012-0918-i. [PubMed] [CrossRef] [Google Scholar]

31. Singh AN, Bansal VK, Misra MC, Kumar S, Rajeshwari S, Kumar A, Sagar R, Kumar A. Testicular functions, chronic groin hurting,and quality of life afterwards laparoscopic and open up meshrepair of inguinal hernia: a prospective randomized controlled trial. Surg Endosc. 2012;26(5):1304–1317. doi: 10.1007/s00464-011-2029-y. [PubMed] [CrossRef] [Google Scholar]

32. Hallén M, Westerdahl J, Nordin P, Gunnarsson U, Sandblom M. Mesh hernia repair and male infertility: a retrospective register report. Surgery. 2012;151(1):94–98. doi: ten.1016/j.surg.2011.06.028. [PubMed] [CrossRef] [Google Scholar]

33. Skawran Southward, Weyhe D, Schmitz B, Belyaev O, Bauer KH. Bilateral endoscopic total extraperitoneal (TEP) inguinal hernia repair does not induce obstructive azoospermia: data of a retrospective and prospective trial. World J Surg. 2011;35(7):1643–1648. doi: ten.1007/s00268-011-1072-0. [PubMed] [CrossRef] [Google Scholar]

34. Hallén M, Sandblom G, Nordin P, Gunnarsson U, Kvist U, Westerdahl J. Male infertility afterward mesh hernia repair: a prospective study. Surgery. 2011;149(2):179–184. doi: ten.1016/j.surg.2010.04.027. [PubMed] [CrossRef] [Google Scholar]

35. Sucullu I, Filiz AI, Sen B, Ozdemir Y, Yucel E, Sinan H, Sen H, Dandin O, Kurt Y, Gulec B, Ozyurt M. The effects of inguinal hernia repair on testicular function in young adults: a prospective randomized study. Hernia. 2010;14(two):165–169. doi: 10.1007/s10029-009-0589-8. [PubMed] [CrossRef] [Google Scholar]

36. Kiladze 1000, Gvenetadze T, Giorgobiani G. Modified Lichtenshtein hernioplasty prevents male infertility. Ann Ital Chir. 2009;80(iv):305–309. [PubMed] [Google Scholar]

37. Chu Fifty, Averch TD, Jackman SV. Testicular infarction every bit a sequela of inguinal hernia repair. Can J Urol. 2009;16(half-dozen):4953–4954. [PubMed] [Google Scholar]

38. Ramadan SU, Gokharman D, Tuncbilek I, Ozer H, Kosar P, Kacar 1000, Temel S, Kosar U. Does the presence of a mesh have an consequence on the testicular blood flow subsequently surgical repair of indirect inguinal hernia? J Clin Ultrasound. 2009;37(2):78–81. doi: 10.1002/jcu.20516. [PubMed] [CrossRef] [Google Scholar]

39. Yamaguchi K, Ishikawa T, Nakano Y, Kondo Y, Shiotani M, Fujisawa M. Chop-chop progressing, late-onset obstructive azoospermia linked to herniorrhaphy with mesh. Fertil Steril. 2008;90(five):2018e5–2018e7. doi: 10.1016/j.fertnstert.2008.04.062. [PubMed] [CrossRef] [Google Scholar]

40. Brisinda M, Cina A, Nigro C, Cadeddu F, Brandara F, Marniga G, Vanella S, Bonomo L, Civello IM. Duplex ultrasound evaluation of testicular perfusion after tension-free inguinal hernia repair: results of a prospective study. Hepato-Gastroenterology. 2008;55(84):974–978. [PubMed] [Google Scholar]

41. Dohle CR, Smit M, Van Den Berg M. Infertility afterward herniorrhaphy. Nederlands Tijdschrift voor Urologie. 2006;14(eight):240–242. [Google Scholar]

42. Langenbach MR, Schmidt J, Zirngibl H. Comparing of biomaterials: three meshes and TAPP for inguinal hernia. Surg Endosc. 2006;20(10):1511–1517. doi: x.1007/s00464-005-0078-9. [PubMed] [CrossRef] [Google Scholar]

43. Nagler HM, Belletete BA, Gerber Eastward, Dinlenc CZ. Laparoscopic retrieval of retroperitoneal vas deferens in vasovasostomy for postinguinal herniorrhaphy obstructive azoospermia. Fertil Steril. 2005;83(6):1842. doi: 10.1016/j.fertnstert.2004.11.083. [PubMed] [CrossRef] [Google Scholar]

44. Akbulut Thousand, Serteser M, Yücel A, Değirmenci B, Yilmaz S, Polat C, San O, Dilek ON. Can laparoscopic hernia repair modify function and volume of testis? Randomized clinical trial. Surg Laparosc Endosc Percutan Tech. 2003;13(6):377–381. doi: 10.1097/00129689-200312000-00006. [PubMed] [CrossRef] [Google Scholar]

45. Aydede H, Erhan Y, Sakarya A, Kara E, Ilkgül O, Can M. Effect of mesh and its localisation on testicular flow and spermatogenesis in patients with groin hernia. Acta Chir Belg. 2003;103(6):607–610. doi: 10.1080/00015458.2003.11679502. [PubMed] [CrossRef] [Google Scholar]

46. Yang KX, Ji YB, Yu WL. 3 cases of infertility after inguinal hernia surgery. J Pract J. 1997;1:56–57. [Google Scholar]

47. Junge One thousand, Binnebösel M, Rosch R, Ottinger A, Stumpf Thou, Mühlenbruch M, Schumpelick V, Klinge U. Influence of mesh materials on the integrity of the vas deferens following Lichtenstein hernioplasty: an experimental model. Hernia. 2008;12(6):621–6. doi: ten.1007/s10029-008-0400-two. [PubMed] [CrossRef] [Google Scholar]

48. Uzzo RG, Lemack GE, Morrissey KP, Goldstein Grand. The furnishings of mesh bioprosthesis on the spermatic cord structures: a preliminary report in a canine model. J Urol. 1999;161(4):1344–1349. doi: 10.1016/S0022-5347(01)61681-i. [PubMed] [CrossRef] [Google Scholar]

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914038/

Posted by: lazarusfround.blogspot.com

Share this post