A Prospective Randomized Comparison of Testicular Function, Sexual Function and Quality of Life Following Laparoscopic Totally Extra Peritoneal (TEP) and Trans Abdominal Pre-Peritoneal (TAPP) Inguinal Hernia Repair

Mahesh C Misra, Prateek Manik, Virinder K Bansal, Krishna Asuri, Rajesh Sagar, Anand Kumar, Subodh Kumar, Atin Kumar, Rajeshwari Subramaniam. All India Institute of Medical Sciences

Background: Testicular atrophy following groin hernia repair is a major concern for any male patient. There is very scant literature regarding the impact of inguinal hernia and its mesh repair on testicular function and sexual function following both open and laparoscopic techniques. The present study was designed to compare TAPP and TEP repair in terms of testicular and sexual function, quality of life and chronic groin pain.

Methods: The study was conducted from November 2012 to June 2014. 160 patients with uncomplicated groin hernia were randomized to Trans-Abdominal Pre-Peritoneal (TAPP) or Totally Extra-Peritoneal (TEP) techniques. Testicular functions were assessed by measuring testicular volume, testicular hormone levels pre operatively and at 3 months post operatively. Sexual function were assessed using BMSFI and quality of life using WHO-QOL BREF scale pre operatively and at 3 months post operatively. Chronic groin pain was evaluated using the VAS scale at 3 months , 6 months and at 1 year

Results: The median duration of follow up was 13 months (range 6 months to 18 months) There was no statistically significant difference in terms of chronic groin between the TAPP and TEP repair groups at 3 months (p value 0.06) and 6 months (p value 0.86) follow up. The testicular resistive index and testicular volume did not show any significant change from the pre-operative value to the follow up at 3 months (p value 0.9) in the study population. On further analysis no significant difference was also seen in testicular resistive index and testicular volume at follow up of 3 months as compared to pre-operative value in both TAPP and TEP groups (p value >0.05). There was a statistically significant improvement in the sexual drive score, erectile function and overall satisfaction over a follow up following laparoscopic inguinal hernia repair. However there was no difference between TEP and TAPP group All the domains of Quality of Life in the study population showed a significant improvement at a follow up of 3 months and 6 months. Subgroup analysis of all the domains of Quality of Life in both TAPP and TEP group, showed a similar increment as in the study population (p value <0.001),

Conclusions: Laparoscopic groin hernia repair improves the testicular function, sexual function and quality of life and both TEP and TAPP techniques are comparable with respect to these long term outcomes.

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