Marlex mesh causing inguinal vasal obstruction: a treatable, preventable cause of obstructive azospermia

Combined robotic and subinguinal microsurgical vasovasostomy for vasal obstruction after inguinal hernia repair

Obstruction of the vas deferens may occur after inguinal hernia repair with mesh and lead to infertility. In cases where natural conception is desired and after obtaining test results that suggest the presence of spermatogenesis, surgical reconstruction can be attempted but may be difficult. Several approaches have been reported, including the laparoscopic mobilisation of the pelvic vas deferens, as well as mobilisation and passage of the scrotal vas deferens intra-abdominally for robot-assisted vasovasostomy. We describe a novel approach that used the surgical robot and a no-touch technique to mobilise the pelvic vas deferens and deliver it to the subinguinal region for subinguinal microsurgical vasovasostomy. This approach appeared to be feasible and safe, allows for simultaneous bilateral repair if needed, and was associated with rapid postoperative convalescence.

Laparoscopic retrieval of retroperitoneal vas deferens in vasovasostomy for postinguinal herniorrhaphy obstructive azoospermia

OBJECTIVE

Iatrogenic injury to the vas deferens is a well-documented complication of inguinal hernia repair. Recently obstruction related to the use of polypropylene mesh for hernia repair has been reported. We describe a case using laparoscopy to mobilize the retroperitoneal vas and deliver it to the healthy vas proximal to the vas trapped in the cicatrix induced by mesh thus allowing a tension-free microsurgical repair.

DESIGN

Case report.

SETTING

Outpatient male infertility practice.

PATIENT(S)

Obstructed azoospermic men with polypropylene mesh.

INTERVENTION(S)

Laparoscopic retrieval of retroperitoneal vas segment for primary microsurgical anastomosis.

MAIN OUTCOME MEASURE(S)

Patency of vas and presence of sperm.

RESULT(S)

A tension-free, patent anastomosis was performed.

CONCLUSION(S)

Polypropylene mesh-induced fibrosis of the vas deferens can result in obstructive azospermia. Laparoscopy can be used to permit a microsurgical bypass of the obstructed segment.