title: Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial.
abstract: BACKGROUND
  Laparoscopic inguinal hernia repair is still not the gold standard for patients with inguinal hernia. The aim of this study was to compare testicular dysfunction, incidence and factors influencing chronic groin pain, and quality of life after laparoscopic and open mesh repair.
  
  
  METHODS
  One hundred twenty patients were studied in a prospective randomized trial. One hundred seventeen patients completed the required follow-up, 60 following laparoscopic repair and 57 following open repair. Testicular functions were assessed by testicular volume, blood flow, and hormones, and quality of life was assessed with Short Form 36 version 2 preoperatively and postoperatively at 3 months. Pain was assessed at different time intervals preoperatively and postoperatively.
  
  
  RESULTS
  Preoperative profiles of both groups were well matched. A significant decrease in testicular volume (p = 0.01) and less improvement in blood flow (p = 0.048) was seen after open repair. There was also a significant reduction in serum testosterone level (p = 0.02) with a significant increase in FSH and LH level (p < 0.001); however, there was no testicular atrophy. Incidence and severity of chronic groin pain were significantly less after laparoscopic repair during normal and strenuous activities, though they were similar to those after open repair during rest after 3 months postoperatively. Age, preoperative pain, pain at 1 week, and open repair were found to be independent risk factors for chronic pain on multivariate analysis. Quality of life was significantly better postoperatively in terms of physical functions, role physical, bodily pain, and general health after laparoscopic repair.
  
  
  CONCLUSIONS
  Laparoscopic repair seems favorable in terms of better preservation of testicular functions, lower incidence of acute and chronic groin pain, and significant improvement in quality of life when compared to open repair. Younger age, preoperative pain, pain after 1 week postoperatively, and open mesh repair were found to be significant risk factors for chronic groin pain.
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India.
authors.forename: Anand Narayan
authors.initials: AN
authors.lastname: Singh
authors.forename: Virinder Kumar
authors.initials: VK
authors.lastname: Bansal
authors.forename: Mahesh C
authors.initials: MC
authors.lastname: Misra
authors.forename: Subodh
authors.initials: S
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Rajeshwari
authors.forename: Atin
authors.initials: A
authors.lastname: Kumar
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sagar
authors.forename: Anand
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000209:etiology / Q000503:physiopathology; D006119:Groin; D006552:Hernia, Inguinal / Q000601:surgery*; D006728:Hormones / Q000378:metabolism; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D011788:Quality of Life; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology; D013733:Testicular Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D013737:Testis / Q000098:blood supply; D055815:Young Adult
chemical_list: D006728:Hormones
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