Advantages of Isolation Hernioplasty in Modeled Inguinal Hernioplasty in an Experiment

Abstract

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.