Damage to the spermatic cord by the Lichtenstein and TAPP procedures in a pig model.
BACKGROUND
Mesh implantation is regarded as the standard treatment of inguinal hernias. Obstructive azoospermia induced by mesh implantation is a rare but serious complication. Whether different operative techniques or mesh materials used have an effect on the integrity of the testicle and spermatic cord remains unclear.


METHODS
In 12 minipigs a bilateral inguinal hernia repair, either open or laparoscopic, was performed using a standard small-pore polypropylene (PP) or large-pore polyvinyliden fluoride (PVDF) mesh. Next to measurement of the testicular size, thermography of the groin and testicle as a parameter for perfusion was performed preoperatively and at a follow-up at 6 months. Obstructions of the vas deferens were estimated radiographically. Testicular function (Johnson score) and mesh integration (granuloma size, apoptotic cells) were analyzed histologically.


RESULTS
Mean testicular size did not change significantly in follow-up compared to preoperative values. Technique and mesh material used failed to have a significant influence. Thermography of the groin following the Lichtenstein technique had significantly higher values at follow-up regardless of the mesh used. This could not been shown for laparoscopic treatment. Thermographic measurements at the testicle showed a significantly increased temperature in all groups compared to preoperative measurements. Only the Lichtenstein PP group showed significantly decreased values in testicular function. Quantity and quality of obstructions seen at vasography were most detectable in the Lichtenstein PP group. There was significantly decreased granuloma formation following PVDF mesh implantation compared to the PP mesh group regardless of the technique used.


CONCLUSIONS
Both the technique and the mesh material have an impact on integrity of spermatic cord and testicular function. According to the results of this study, the laparoscopic TAPP procedure using a large-pore PVDF mesh has the least effect compared to preoperative values.
Department of Surgery, Technical University of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. kjunge@ukaachen.de
Karsten
K
Junge
Marcel
M
Binnebösel
Caroline
C
Kauffmann
Raphael
R
Rosch
Christian
C
Klink
Klaus
K
von Trotha
Felix
F
Schoth
Volker
V
Schumpelick
Uwe
U
Klinge
D000818:Animals; D053713:Azoospermia / Q000209:etiology / Q000517:prevention & control; D004867:Equipment Design; D005549:Foreign-Body Reaction / Q000209:etiology; D006552:Hernia, Inguinal / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D011126:Polypropylenes; D011145:Polyvinyls; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D011859:Radiography; D013085:Spermatic Cord / Q000293:injuries*; D013526:Surgical Mesh / Q000009:adverse effects*; D034421:Sus scrofa; D013552:Swine; D013737:Testis / Q000503:physiopathology*; D013817:Thermography; D014649:Vas Deferens / Q000000981:diagnostic imaging; D005465:Fluorocarbon Polymers
D011126:Polypropylenes; D011145:Polyvinyls; C024865:polyvinylidene fluoride; D005465:Fluorocarbon Polymers