A clinical comparison of the effect of spermatic vessels and testicular function between the two laparoscopic inguinal herniorrhaphy in male patients with inguinal hernia / 中国医师杂志

ABSTRACT

Objective To compare the effect of spermatic vessels and testicular function between totally extraperitoneal prosthetic (TEP) and transabdominal preperitoneal hemia repair (TAPP) in male patients with inguinal hernia.Methods Forward-looking inclusion of 186 male patients with IH in our hospital from October 2015 to January 2018.All of them were randomly divided into two groups by computer code,105 patients underwent totally extraperitoneal prosthetic (TEP Group),and 81 patients underwent transabdominal preperitoneal hernia repair (TAPP Group).The operation time,the postoperative time of spontaneous getting out of bed,the time of hospitalization after operation,the pain score on the first day after operation,the condition of spermatic cord vessels,testicular function and complications of the two groups were compared before and 4 weeks after operation.Results There was no perioperative deaths and serious complications during perioperative in the two groups.No patient was transfered to open the abdomen.There was no statistically significance in operation time,the postoperative time of spontaneous getting out of bed,the time of hospitalization after operation,the pain score on the first day after operation [(47.57 ± 5.38)min vs (48.93 ±6.27)min;(1.25 ±0.32)d vs (1.38 ±0.52)d;(2.38 ± 1.14)d vs (2.46 ± 1.81)d;(1.27 ±0.47) point vs (1.42 ± 1.93)point].There was no significant difference in spermatic artery diameter,blood flow velocity,semen quality and serum testosterone between TEP group and TAPP group before and 4 weeks after operation (P ＞ 0.05).However,in TAPP group,the diameter of spermatic vein was wider and the blood flow velocity 4 weeks after operation was slower than that before operation,with statistically significant difference [(2.08 ± 0.23) mm vs (1.97 ± 0.11) mm;(1.72 ± 0.12) cm/s vs (1.94 ± 0.03)cm/s,P ＜ 0.05].In addition,TEP group was better than TAPP group in the diameter of spermatic vein and the velocity of blood flow 4 weeks after operation,with statistically significant difference [(1.98 ± 0.14) mm vs (2.08 ±0.23)mm;(1.87 ±0.16)cm/s vs (1.72 ±0.12)cm/s].There were both 1 cases of incision infection in TEP and TAPP group after operation (0.95％,1.23％).In TEP group,2 patients (1.90％)developed edema of the scrotum or labia minora,and there were 3 cases (3.70％) in TAPP group.The patients were followed up for 3-16 months (median 10 months),and there were 1 recurrences in group TAPP.There was no significant difference in postoperative complications (P =0.582).Conclusions Both TEP and TAPP were safe and effective in the treatment of inguinal hernia.And both of them had no significant effect on spermatic artery and testicular function.However,the effect of TEP on spermatic blood flow was less than that of TAPP.