The Effects of Mesh Bioprosthesis on the Spermatic Cord Structures: A Preliminary Report in a Canine Model

Uzzo, Robert G.; Lemack, Gary E.; Morrissey, Kevin P.; Goldstein, Marc

doi:10.1016/s0022-5347(01)61681-1

Cited by 116 publications

(83 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…24 Possible damage to the spermatic cord and nerve entrapment following mesh repair due to extensive fibrosis are also concerns raised by this technique. 25 Depending on the level of expertise and the degree of handling the incidence of post-operative pain is greatly altered. Yet the results from a study conducted by Danielson et al amongst a list of open repairs Lichtenstein's requires lesser expertise with a less steep learning curve.…”

Section: Discussionmentioning

confidence: 99%

Desarda’s versus Lichtenstein technique of inguinal hernia repair

Obaid¹

2017

Int Surg J

View full text Add to dashboard Cite

INTRODUCTIONInguinal hernia is one of the most common diseases manage by surgeon.1 A hernia is abnormal protrusion of a viscus or a part of viscus through an opening in the wall of cavity containing it. It tends to occur at natural areas of weakness, where muscles are not strong and are vulnerable to intra-abdominal pressure. The estimated lifetime risk for inguinal hernia is 27% for men and 3% for women. 2The choice of a surgery depends on the surgeon as there were no written surgical guidelines for hernia treatment till 2009. [3][4][5] There is a considerable variation in the efficiency of all these procedures which is calculated by the rate of recurrence, complications which is also influenced not only by the different techniques but also by experience and the technical skills of the surgeons. 6 However, the ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent ABSTRACT Background: Ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent achieves this entire goal. The Lichtenstein mesh repair is associated with complications, postoperative dysfunction and high cost composite meshes. Desarda's technique, became a new surgical option for tissue-based inguinal hernia repair. The present study was designed to evaluate and compare the effectiveness and complications of the Desarda's repair with Lichtenstein tension-free mesh repair for treatment of inguinal hernia in a developing country. Methods: 200 patients with unilateral, primary, reducible inguinal hernia were selected. Included patients were randomly divided into two groups. Studied parameters were Duration of surgery, intra operative complications, postoperative Pain, Duration of hospital stay, return to normal activities, post-operative complications and recurrences. Results: There were a total of 100 patients each group. There was no statistically significant difference in duration of surgery and complication rate between the two groups. Difference in mean VAS was not statistically significant. The mean hospital stay in Desarda's technique was 2.5 days while it was 2.6 days in Lichtenstein's group. The mean time to return to basic physical activity in the Desarda's technique was 12.6 days while it was 13.3 days in the Lichtenstein's group. There were no recurrences in either group. Chronic inguinal pain (>1month) was more frequent in Lichtenstein's group. Conclusions: There is no significant difference in duration of surgery, intra operative complication rate, postoperative pain, complications and recurrence, between Desarda's technique and Lichtenstein's technique. However chronic inguinal pain is less in Desarda's technique. Desarda's repair must be considered in young patients (<30 years). Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up.

show abstract

Section: Discussionmentioning

confidence: 99%

Desarda’s versus Lichtenstein technique of inguinal hernia repair

Obaid¹

2017

Int Surg J

View full text Add to dashboard Cite

show abstract

“…The testicular artery is the principal source of nutrition for testicles, and its diameter may reach 1.5 mm 13 . The right branch of the aorta emerges at the level L2, from where it continues through the retroperitoneum to penetrate into the spermatic funiculus.…”

Section: Analysis Of the Testicular Flowmentioning

confidence: 99%

“…The right branch of the aorta emerges at the level L2, from where it continues through the retroperitoneum to penetrate into the spermatic funiculus. There are good anastomoses between the testicular artery and the deferens artery 13,23 . There were no alterations to systolic and diastolic velocity over the course of time, by comparing the results from the three observation times for each group (Tables 1 to 4).…”

Section: Analysis Of the Testicular Flowmentioning

confidence: 99%

“…They also observed changes in temperature, testicular volume, testosterone levels, blood perfusion and reduction in the diameter of the vas deferens, which were attributed to the foreign-body reaction caused by the prostheses. The testicular histology and spermatic motility and morphology may also be impaired, according to these authors 13 . Klinge et al 14 reoperated 17 patients in whom prostheses had been implanted and they observed the following histological alterations: foreign-body reaction; granuloma with epithelial cells and giant cells, fibrinoid necrosis in some cases and extensive collagen deposits.…”

Section: Introductionmentioning

confidence: 97%

“…Yavetz et al 12 studied 8,500 infertile men with and without testicular atrophy and found that 565 of the men without testicular atrophy (6.65%) had undergone inguinal hernioplasty. Uzzo et al 13 in an experimental canine model, observed that the polypropylene prosthesis promoted a fibroblastic response that could lead to the formation of fibrotic adherences between the mesh and the spermatic funiculus. They also observed changes in temperature, testicular volume, testosterone levels, blood perfusion and reduction in the diameter of the vas deferens, which were attributed to the foreign-body reaction caused by the prostheses.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia

2007

View full text Add to dashboard Cite

Purpose:To evaluate testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia, with polypropylene prosthesis. Methods: This was an observational prospective clinical study on 39 male patients with unilateral inguinal hernia of types III A and III B according to the Nyhus classification who underwent surgical correction with implantation of a polypropylene prosthesis by means of the Lichtenstein technique. The patients were evaluated using Doppler ultrasound before the operation and selectively at the third and sixth months after the operation. The variables studied were testicular volume, systolic and diastolic velocity, resistance index and pulsatility index. Results: No statistically significant alterations in the variables studied were observed over the course of time: testicular volume (p= 0.197); systolic velocity (p= 0.257); diastolic velocity (p= 0.554); resistance index (p= 0.998); and pulsatility index (p= 0.582). Conclusion: No alteration in testicular volume and arterial flow over a six-month period was observed among patients who underwent surgical correction for inguinal hernia using a polypropylene prothesis. Key words: Testis. Surgical Mesh. Hernia, Inguinal. RESUMO Objetivo:Avaliar o volume testicular e o fluxo na artéria testicular em pacientes operados de inguinal com prótese de polipropileno. Métodos: Estudo clínico prospectivo observacional em 39 pacientes do sexo masculino portadores de hérnia inguinal tipo III A e III B na classificação de Nyhus os quais foram submetidos a hernioplastia inguinal com implantação de prótese de polipropileno com a técnica de Lichtenstein. Os pacientes foram avaliados com ultra-sonografia Doppler no pré-operatório; no 3º mês e no 6º mês de pós-operatório. As variáveis estudadas foram: volume testicular; velocidade sistólica e diastólica, o índice de resistividade e o índice de pulsatilidade. Resultados: Não se observou alterações estatisticamente significantes nas variáveis ao longo do tempo: volume testicular (p=0,197); velocidade sistólica (p=0,257); velocidade diastólica (p=0,554); índice de resistividade (p=0,998); índice de pulsatilidade (p=0,582). Conclusão: Não se observou alteração no volume testicular e no fluxo sanguíneo da artéria testicular após seis meses nos pacientes submetidos à correção cirúrgica de hérnia inguinal com prótese de polipropileno.. Descritores: Testículo. Telas Cirúrgicas. Hérnia Inguinal. -ORIGINAL ARTICLE

show abstract

The long‐term effect of mesh bioprosthesis in inguinal hernia repair on testicular nitric oxide metabolism and apoptosis in rat testis

Taneli

Aydede

Vatansever

et al. 2004

Cell Biochemistry & Function

View full text Add to dashboard Cite

Polypropylene mesh is the most widely used material in inguinal hernia repair. Although polypropylene mesh is known as an inert material, it is experimentally proven that mesh generates a chronic inflammatory tissue reaction. The aim of the present study was to investigate the long-term effects of polypropylene mesh material used in inguinal hernia operations on testicular function, testicular nitric oxide (NO) metabolism and germ cell-specific apoptosis in rats. The study comprised 40 male rats that were randomly allocated into two groups. In group 1, the left spermatic cord was elevated and a 0.5 x 1 cm polypropylene mesh was placed behind the left inguinal spermatic cord and group 2 consisted of the sham-operated controls. Blood samples were taken at 6 months preoperatively and postoperatively after to assess luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels for hormonal evaluation. Testicular NO was evaluated by the Griess method, apoptosis by a TUNEL method and inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS) expressions by immunohistochemical staining. Mild (+) eNOS expression was observed in all specimens. Mild (+) iNOS expression was only detected in ipsilateral testis of the mesh-implanted study group. Apoptotic cells were not detected in any samples. We are of the opinion that long-term polypropylene mesh implantation has no effect on testicular hormonal function and only a limited effect on nitric oxide levels and this effect is not sufficient to cause apoptosis in testis that could lead to infertility. It seems that mesh implantation is a reliable method in inguinal hernia repair; however, further work is required by more sensitive methods to fully elucidate the potential testicular damage.

show abstract

The Effects of Mesh Bioprosthesis on the Spermatic Cord Structures: A Preliminary Report in a Canine Model

Cited by 116 publications

References 13 publications

Desarda’s versus Lichtenstein technique of inguinal hernia repair

Desarda’s versus Lichtenstein technique of inguinal hernia repair

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia

The long‐term effect of mesh bioprosthesis in inguinal hernia repair on testicular nitric oxide metabolism and apoptosis in rat testis

Contact Info

Product

Resources

About