Male genital tract injuries after contemporary inguinal hernia repair

Ridgway, Paul F.; Shah, Jyoti; Darzi, Ara

doi:10.1046/j.1464-410x.2002.02844.x

Cited by 49 publications

(35 citation statements)

References 37 publications

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“…Several patients included in the study had a high level of physical activity and/or concerns about infertility. 29,30 One patient was concerned about adhesions that might be produced by a synthetic mesh and the potential for mesh-associated complications if robotic prostatectomy were to be needed in the future.…”

Section: Resultsmentioning

confidence: 99%

“…Patients who favored biologic matrix versus synthetic mesh included some with previous unsuccessful open repair attempts with synthetic mesh, others with persistent pain and discomfort following contralateral inguinal herniorrhaphy with synthetic mesh, and young adults concerned about complications that could lead to infertility. 29,30 Some patients with a high level of physical activity chose laparoscopy and biologic matrix. Their decisions were based on the benefits of rapid return to activity associated with laparoscopic versus open repair and a desire to reduce the risk of chronic pain, which might be associated with synthetic mesh products.…”

Section: Discussionmentioning

confidence: 99%

“…16 There have been some cases of infertility associated with insertion of synthetic mesh in the retropubic space, 30 and several studies have suggested that inadvertent injury to the vas deferens during laparoscopic herniorrhaphy may play a role in fibrosis formation around the spermatic cord. 29,30 With the recent advances in robotic prostatectomy, the presence of synthetic mesh in the retropubic space after hernia repair might prevent future minimally invasive prostatectomy; Tsivian and colleagues 41 describe problems with access and adhesions in the Retzius space that may affect the course of an individual urologic operation and contribute to an overall higher degree of operative difficulty.…”

Section: Discussionmentioning

confidence: 99%

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Placement of a Non–Cross-Linked Porcine-Derived Acellular Dermal Matrix During Preperitoneal Laparoscopic Inguinal Hernia Repair

Alshkaki

2013

International Surgery

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This retrospective chart review evaluated outcomes following laparoscopic inguinal herniorrhaphies with non-cross-linked intact porcine-derived acellular dermal matrix (PADM) by one surgeon in a community teaching facility hospital. Mesh was sutured and/or tacked in the preperitoneal space. Postoperative visits were scheduled at 2 weeks, 3 months, and 6 months, and then at 6-month intervals up to 2 years. PADM was placed in 14 male patients (mean age, 41.1 years). Seven patients had bilateral hernias. One patient required intraoperative conversion to open herniorrhaphy based on diagnostic laparoscopy findings. PADM sizes were 6 3 10 to 12 3 16 cm; mean operative time was 102 minutes. All patients were discharged on the day of surgery and resumed full activity. This treatment approach was effective, with no recurrence or complications during a median follow-up period of 18 months (range, 13-25 months). Synthetic mesh is often used in conjunction with both open and laparoscopic inguinal herniorrhaphy and has been shown to significantly reduce the risk of hernia recurrence compared with primary repair without mesh.9 However, synthetic mesh has been associated with postoperative complications such as infection, which can occur during the acute or longterm postsurgical period, [13][14][15] and longer-term complications such as chronic pain, fistula formation, and extrusion. [16][17][18][19] Infection following synthetic mesh insertion 19,20 often leads to explantation of the mesh, which may result in increased patient morbidity and use of health care resources. 20,21 Biologic matrices support tissue revascularization and are thought to resist infection better than synthetic meshes.13 Several biologic alternatives to synthetic mesh have been developed, including a non-cross-linked intact porcine-derived acellular dermal matrix (PADM; Strattice Reconstructive Tissue Matrix, LifeCell Corporation, Branchburg, New Jersey). The structure of PADM is strong and biocompatible, and it allows for cellular infiltration, vascularization, and tissue remodeling. 22 Clinical studies have shown the utility of PADM in several surgical procedures, including chest wall reconstruction, 23 breast reconstruction surgery, 24 and ventral herniorrhaphy. 25 To date, limited data have been reported about biologic matrix use in laparoscopic inguinal herniorrhaphy. [26][27][28] To the author's knowledge, results from studies assessing the use of PADM in laparoscopic inguinal hernia repair have not been previously reported. This retrospective chart review evaluated the results of laparoscopic inguinal herniorrhaphy in 14 patients using a totally extraperitoneal (TEP) approach with placement of PADM. Postoperative recurrence and complication rates associated with this procedure were evaluated for a median follow-up period of 18 months (range, 13-25 months). Patients and MethodsA retrospective chart review was conducted to identify patients who underwent elective laparoscopic inguinal herniorrhaphy with use of PADM performed by the author in a commu...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Placement of a Non–Cross-Linked Porcine-Derived Acellular Dermal Matrix During Preperitoneal Laparoscopic Inguinal Hernia Repair

Alshkaki

2013

International Surgery

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“…In the most common scenario, an unrecognized injury is revealed only years later in the evaluation of subfertile or azoospermic men who underwent hernia repair during childhood. 7,[9][10][11] Unlike in adults, inguinal hernia repair in children is the most common cause of injury to the vas deferens, 9 which is more delicate and attenuated in infants. Early reports suggested that vasal injury occurs in 0.8% to 2% of pediatric hernia cases.…”

Section: Discussionmentioning

confidence: 99%

“…10,13 The prominent location of the vas and gonadal vessels must be noted when placing the mesh, especially during bilateral herniorrhaphy. Longer-term follow-up of the fertility of young men who undergo bilateral laparoscopic hernia repair should be considered.…”

Section: Discussionmentioning

confidence: 99%