Sexual dysfunction and male infertility as long-term complications of inguinal hernia mesh repair

Abstract

Background. Inguinal wall reinforcement with a synthetic mesh remains a gold standard therapy for a hernia with good clinical outcomes; however, presence of a prosthetic material close to the spermatic cord may influence male fertility due to vas deferens obstruction. Objective of the study. The aim of this study was to analyze the long-lasting impact of different hernioplasty techniques on sexual function. Material and methods. A bibliographic search for specialized free available English literature was performed in PubMed database according to the MeSH terms: “inguinal hernia”, “prosthetic mesh”, “sexual function”, “fertility”, article type – clinical trial, publication period – 2010-2024. Results. A total of 5 trials comparing the outcome of laparoscopic and open surgeries for groin hernia repair were assessed. The randomized clinical trials comparing open (Lichtenstein tension-free) vs laparoscopic (TAPP or TEP) approaches demonstrated no sexual changes in the groups with a significant positive impact in terms of fertility indices determined by the improvement in testicular vascularity, physical function, emotional aspects, bodily pain, and general health. The trial CTRI/2018/05/013,621 comparing laparoscopic repair TAPP vs TEP showed statistically significant amelioration in overall sexual function score and failed to identify differences between the groups depending on the technique. A Belgian randomized trial NCT00925067 aimed to evaluate the effects of lightweight vs heavyweight meshes. Even lightweight meshes are supposed to be more biocompatible due to lower body reaction and less fibrosis, they had no advantages with regard to semen analysis registered within 3 year follow-up. Conclusion. The studies have shown that inguinal hernia repair leads on to improvement in sexual functions and fertility indices with no significant differences based on surgical approach or synthetic mesh type.