Tension-free inguinal hernia repair for augmentation of the inguinal canal used to be popular. Techniques using meshes can be performed under local anesthesia and result in excellent patient comfort and low rates of recurrence. Unfortunately, fibrotic healing can result in hardening and shrinking of the mesh. Zieren and colleagues investigated testicular perfusion and sexual functioning in men following plug and patch repair of inguinal hernia.

The study included 73 men undergoing surgery for primary inguinal hernia at a German university hospital. Men younger than 18 years, those with recurrent or incarcerated herniae, and those with scrotal diseases (tumor, orchitis) were excluded from the study. All surgeries were performed under local anesthesia and involved use of Prolene plugs behind the internal ring plus a patch under the external aponeurosis. Testicular volume and blood flow in the spermatic artery were measured by scrotal ultrasonography and color duplex sonography preoperatively, three months postoperatively and then every six months. Sexual function was assessed using a standardized questionnaire containing 40 items.

The average age of the men was 57 years. Most herniae (71 percent) were indirect. No complications occurred during surgery; 27 patients had superficial complications such as wound hematoma, seroma, infection or neuralgia pain following the procedure. Before surgery, 11 (15 percent) men experienced inguinal pain during sex because of the hernia. Postoperative testicular volume and blood flow measurements showed no significant change from preoperative levels. Sexual disorders attributed to inguinal pain were significantly reduced following surgery. However, 10 (14 percent) patients described new limitation of sexual activity following surgery. Four of these were attributed to pain and six to loss of sensation. In six of these patients, symptoms resolved spontaneously within one year. No correlation could be made between sexual symptoms and measures of testicular volume or blood flow.

The authors conclude that there is, so far, no evidence of impairment of cord structures or sexual function following inguinal hernia repair using mesh techniques.

editor's note: Family physicians are frequently asked the questions that patients hesitate to ask specialists, including surgeons. In addition, family physicians learn to recognize the hesitancy of a patient who has an unvoiced concern about a “minor, routine surgery”. This study empowers physicians to ask men if they are concerned about sexual performance after hernia surgery and to reassure them and their partners.—a.d.w.