The Influence of Inguinal Mesh Repair on the Spermatic Cord: A Pilot Study in the Rabbit

Abstract

The permanent implantation of a polypropylene mesh during inguinal hernia repair causes chronic inflammatory changes in the surrounding tissue. We investigated the effect of this foreign body reaction on the structures of the spermatic cord in the rabbit. Eight Chinchilla rabbits underwent unilateral inguinal hernia repair by the Lichtenstein technique using Marlex (n = 4) or Ultrapro (n = 4) mesh. The contralateral side was operated upon using the Shouldice repair. Three animals served as controls. Three months after operation we analyzed testicular size, testicular temperature, and arterial perfusion by excitation light of a 780-nm laser after injection of 0.5 mg/kg indocyanin green. Histological evaluation included spermatogenesis (Johnsen score) and foreign-body reaction. Testicular volume increased about 10% after each operation. The decrease of arterial perfusion and testicular temperature was more significant after mesh repair than following Shouldice operation. After mesh implantation we found fewer seminiferous tubules classified as Johnsen 10 (Marlex: 51.3%, Ultrapro: 45.0%) than after Shouldice repair (63.8%) or in the controls (65.8%). The spermatic cord showed a typical foreign-body reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. Preserved cremasteric muscle fibers protected the structures of the spermatic cord. The inflammatory foreign-body reaction of the surrounding tissue induced by the inguinal prosthetic mesh includes the structures of the spermatic cord. This may have an influence also on spermatogenesis. Therefore, we recommend strict indications for implantation of a prosthetic mesh during inguinal hernia repair.

Influence of hernioplastic implants on male fertility in rats

“…26 In the porcine model, similar results were obtained. 27 Comparison of polypropylene and vypro meshes in the rabbit model provoked adhesions comparable to those recorded in this study.…”

Male infertility after mesh hernia repair: A prospective study

“…The risk for infertility after mesh repair, as proposed by other authors 4,5,9,10 , has been regarded as an important question. Our results indicate that at the informed consent, the surgeon should not focus on the infertility problem.…”

“…In contrast others have found proximal dilatation but no thickening of the wall of the vas deferens 2 . Decreased arterial perfusion in the testis 5,7 and spermatic venous thrombosis 4 have also been reported.. One study has shown beneficial effects on the integrity of the vas deferens when using lightweight mesh 3 whereas another study did not find any difference in inflammation and fibrosis comparing heavyweight with lightweight mesh 8 .…”

Influence of a new self-gripping hernia mesh on male fertility in a rat model

“…It is the only tubular organ of the body in which the diameter of the lumen is less than the thickness of the wall. As the ductus deferens is a quite sensitive structure, especially in juveniles [10], the effect of hernia meshes on it was addressed by several authors, both in humans [6,7,11,12] and in animal models (canine [13,14]; porcine and rabbit [15,16]; rat [5,[17][18][19][20]). …”