Advantages of Isolation Hernioplasty in Modeled Inguinal Hernioplasty in an Experiment

Elguja Ardia, Tamaz Gvenetadze, Nino Megrelishvili, Teimuraz Gorgodze, Emzar Diasamidze, Revaz Otarashvili


Introduction: The Lichtenstein method revolutionized the treatment of inguinal hernias. Since then, many methods of hernioplasty have been proposed, of which the so-called isolation methods are gaining more and more relevance, which implies complete spermatic cord isolation from the mesh, in order to avoid the inclusion of the spermatic cord in the inflammatory process, which can cause a violation of the ejaculation function and spermatogenesis itself, as the Lichtenstein method is accompanied by such a serious Complications such as: development of fibrous changes in the spermatic cord, deejaculation, obstructive azoospermia, oligospermia. These complications have been proven by experimental and clinical studies, due to the close contact of the rope with the mesh and are conditions that contribute to infertility in men.

Aim of the study: Study of subsequent changes in the vas deferens during modeled inguinal hernioplasty in the experiment, in the groups that underwent hernioplasty by Lichtenstein's method and complete spermatic cord isolation by Gvenetadze's method.

Material and methods: 16 male rabbits aged 12 months ± 3 months, weighing 3.5 ± 0.5 kg were included in the study. Of these, 8 (50%) underwent hernioplasty by Lichtenstein's method, and 8 (50%) - with spermatic cord isolation from a mesh by Gvenetadze's method. Rabbits were divided into two groups. The first group: 8 rabbits, which underwent Lichtenstein's hernia surgery. The second group: 8 rabbits, which underwent hernioplasty with complete spermatic cord isolation by Gvenetadze's method. Vasography was performed in both groups 6 months after the operation, the patency of the ductus deferens and the degree of obstruction were studied.

Results: Our experimental study showed that changes in the vas deferens after the operation occurred only in the first group (P<0.05), no changes were observed in the second group. During the Lichtenstein method, <25% narrowing of the vas deferens was observed in 12.5%, 25-75% narrowing was observed in 50%, and >75% narrowing was observed in 37.5%. During the Gvenetadze method, no changes were observed in the vas deferens.

Conclusion: the experimental method showed the narrowing and interruption of the vas deferens during the Lichtenstein method, which is the reason for the development of obstructive azoospermia and oligospermia and contributes to the development of infertility in men. The mentioned experimental study reliably confirms the negative aspects of Lichtenstein's method, which should be taken into account, especially in men of reproductive age. The isolation method claims that these changes do not develop in the vas deferens, tension-free isolation hernioplasty is simple, prevents male infertility and does not affect spermatogenesis.


Inguinal hernia; Vasography; Male infertility; Experiment;

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Ardia E, Gvenetadze T, Gorgodze T. Inguinal hernia and hernioplasty as a cause of male reproductive system dysfunction (review of literature). SCIENTIFIC JOURNAL „SPECTRI “. 2022 Jun 15;1.

Gorgodze T, Gvenetadze T, Ugrehelidze A, Taboridze I. Evaluation of quality of life after inguinal hernia repair. Black Sea Scientific Journal of Academic Research. 2019;44(1):57-60.

Gventadze T., Giorgobiani G., Gagnidze T., Kingsnorth A, Spermatic cord Isolation from a mesh avoids male infertility., 3rd International Hernia Congress., Boston. USA, June 7-11, 2006, p224

Kordzadeh A, Liu MO, Jayanthi NV. Male infertility following inguinal hernia repair: a systematic review and pooled analysis. Hernia. 2017 Feb;21:1-7.

Peiper C, Junge K, Klinge U, Strehlau E, Öttinger A, Schumpelick V. Is there a risk of infertility after inguinal mesh repair? Experimental studies in the pig and the rabbit. Hernia. 2006 Mar;10(1):7-12

Skawran S, Schmits B, Weghe D. Obstructive azoospermia after bilateral endoscopic total extraperitoneal inguinal hernia repair-the role of surgeon. Hernia. 2009;1(13):25

Magomedov MM, Imanaliev MR, Ismailov GM, Abdulaev UM, Magomedbekov RE. Evaluation of the results of various methods of prosthetic hernioplasty and criteria for predicting the development of early postoperative complications. Bulletin of new medical technologies. 2016;23(4) (Rus).

Ramshorst GH, HS Group. International guidelines for groin hernia management [J]. Hernia. 2018;22(1):1-65.

Public law legal entity L. Sakvarelidze National Center for Disease Control and Public Health. 2021 17 November #06/4914 (Geo).

Chartolani T. Open and laparoscopic prosthetic hernioplasty. 2009 Neomb. p. 35-36.(Geo).

Reinpold W, Chen D. Evidence-based Lichtenstein technique. Der Chirurg; Zeitschrift fur Alle Gebiete der Operativen Medizen. 2017 Apr 1;88(4):296-302

Maciel LC, Glina S, Palma PC, Costa NF, Netto Jr NR. Histopathological alterations of the vas deferens in rats exposed to polypropylene mesh. BJU international. 2007 Jul;100(1):187-90

Sobennikov IS, Zhiborev BN, Kotans SY, Cherenkov AA. Diagnosis and treatment of male infertility in patients with common pathologies of the genitals and groin area. Russian Medical and Biological Bulletin named after Academician IP Pavlov. 2017;25(3) (Rus).

Gvenetadze T, Giorgobiani G, Archvadze V, Gulbani L. Prevention of the development of male infertility after various methods of inguinal hernioplasty using a mesh explant. Surgery news. 2014;22(3) (Rus).

Chen XF, Wang HX, Liu YD, Sun K, Zhou LX, Huang YR, Li Z, Ping P. Clinical features and therapeutic strategies of obstructive azoospermia in patients treated by bilateral inguinal hernia repair in childhood. Asian journal of andrology. 2014 Sep;16(5):745.

Matsuda T. Diagnosis and treatment of post‐herniorrhaphy vas deferens obstruction. International Journal of Urology. 2000 May;7:35-8

Bouchot O, Branchereau J, Perrouin-Verbe MA. Influence of inguinal hernia repair on male fertility. Journal of visceral surgery. 2018 Jun 1;155:S37-40

Yamaguchi K, Ishikawa T, Nakano Y, Kondo Y, Shiotani M, Fujisawa M. Rapidly progressing, late-onset obstructive azoospermia linked to herniorrhaphy with mesh. Fertility and sterility. 2008 Nov 1;90(5):2018-e5

Hallén M, Westerdahl J, Nordin P, Gunnarsson U, Sandblom G. Mesh hernia repair and male infertility: a retrospective register study. Surgery. 2012 Jan 1;151(1):94-8.

Ramadan SU, Gokharman D, Tuncbilek I, Ozer H, Kosar P, Kacar M, Temel S, Kosar U. Does the presence of a mesh have an effect on the testicular blood flow after surgical repair of indirect inguinal hernia?. Journal of Clinical Ultrasound. 2009 Feb;37(2):78-81.

Lelchuk SA, Antonenko FF. Causes of male infertility. Andrology and genital surgery. 2009;10(2):95-1 (Rus).

Kulchenko NG. Morphological changes in the testicle after experimental modeling of inguinal hernia repair. Research'n Practical Medicine Journal. 2021;8(3):62-9 (Rus).

Junge K, Binnebösel M, Rosch R, Öttinger A, Stumpf M, Mühlenbruch G, Schumpelick V, Klinge U. Influence of mesh materials on the integrity of the vas deferens following Lichtenstein hernioplasty: an experimental model. Hernia. 2008 Dec;12(6):621-6

Shin D, Lipshultz LI, Goldstein M, Barmé GA, Fuchs EF, Nagler HM, McCallum SW, Niederberger CS, Schoor RA, Brugh III VM, Honig SC. Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Annals of surgery. 2005 Apr;241(4):553

Wang L, Liu ZY, Piao SG, Xu CL, Hou JG, Gao X, Sun YH. Surgical treatment of azoospermia caused by iatrogenic injury to bilateral vas deferens. Zhonghua nan ke xue= National Journal of Andrology. 2016 Jul 1;22(7):626-9


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