title: 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.
abstract: There is very scant literature on the impact of inguinal hernia mesh repair on testicular functions and sexual functions following open and laparoscopic repair. The present randomized study compares TAPP and TEP repairs in terms of testicular functions, sexual functions, quality of life and chronic groin pain.
  
  
  
  This study was conducted from April 2012 to October 2014. A total of 160 patients with uncomplicated groin hernia were randomized to either trans-abdominal pre-peritoneal (TAPP) repair or totally extra-peritoneal (TEP) repair. Testicular functions were assessed by measuring testicular volume, testicular hormone levels preoperatively and at 3 months postoperatively. Sexual functions were assessed using BMSFI, and quality of life was assessed using WHO-QOL BREF scale preoperatively and at 3 and 6 months postoperatively. Chronic groin pain was evaluated using the VAS scale at 3 months, 6 months and at 1 year.
  
  
  
  The median duration of follow-up was 13 months (range 6-18 months). The mean preoperative pain scores (p value 0.35) as well as the chronic groin pain were similar between TEP and TAPP repairs at 3 months (p value 0.06) and 6 months (p value 0.86). The testicular resistive index and testicular volume did not show any significant change at follow-up of 3 months (p value 0.9) in the study population. No significant difference was observed in testicular resistive index and testicular volume when comparing TEP and TAPP groups at at follow-up of 3 months (p value >0.05). There was a statistically significant improvement in the sexual drive score, erectile function and overall satisfaction over the follow-up period following laparoscopic inguinal hernia repair. However, sexual function improvement was similar in patients undergoing both TEP and TAPP repairs. All the domains of quality of life in the study population showed a significant improvement at a follow-up of 3 and 6 months. Subgroup analysis of all the domains of quality of life in both TAPP and TEP groups showed a similar increment as in the study population (p value <0.001); however, the mean scores of all the domains were comparable between the two subgroups (p value >0.05), preoperatively and 3 and 6 months follow-up.
  
  
  
  Laparoscopic groin hernia repair improves the testicular functions, sexual functions and quality of life, but TEP and TAPP repairs are comparable in terms of these long-term outcomes.
authors: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India. drvkbansal@gmail.com.
authors: Virinder Kumar
authors: VK
authors: Bansal
authors: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
authors: Asuri
authors: A
authors: Krishna
authors: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
authors: Pratik
authors: P
authors: Manek
authors: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
authors: Subodh
authors: S
authors: Kumar
authors: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
authors: Omprakash
authors: O
authors: Prajapati
authors: Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors: Rajeshwari
authors: R
authors: Subramaniam
authors: Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India.
authors: Anand
authors: A
authors: Kumar
authors: Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
authors: Atin
authors: A
authors: Kumar
authors: Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
authors: Rajesh
authors: R
authors: Sagar
authors: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
authors: M C
authors: MC
authors: Misra
mesh_terms: D000293:Adolescent; D000328:Adult; D059350:Chronic Pain / Q000453:epidemiology*; D007172:Erectile Dysfunction; D005640:Follicle Stimulating Hormone / Q000097:blood; D006119:Groin; D006552:Hernia, Inguinal / Q000097:blood / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007989:Libido; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010149:Postoperative Pain / Q000453:epidemiology*; D010537:Peritoneum; D010549:Personal Satisfaction; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D060728:Reproductive Health; D013526:Surgical Mesh; D013737:Testis / Q000033:anatomy & histology; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013739:Testosterone; D005640:Follicle Stimulating Hormone
keywords: Quality of life; Randomized study; Sexual functions; TAPP; TEP; Testicular functions