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Had bilateral inguinal hernia surgery done. Will this affect fertility? Should I be concerned?

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Oncologist, Surgical
Practicing since : 2008
Answered : 576 Questions
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Hi Doctor,

My elder son is 4 and half years old and my younger son is 2 years old. My elder son had bilateral inguinal hernia surgery when he was 6 months old (done by a experienced pediatric surgeon in India). I'm not from medical field. I'm scared about his fertility after reading articles about pediatric hernia surgery in the internet (Article Reference: WWW.WWWW.WW . Even though the surgeon said the surgery was successful, I want a second opinion and clear up my mind.

The above article says that there are several complications associated with Hernia surgery. I have questions on these complications.

1. Regarding vas injury, if vas is injured in pediatric hernia surgery in one side and not injured in other side, does it impact someone to father a child when they become adult?

2. I don't understand when they say about the complication - 'development of sperm-agglutinating antibodies'. What does this mean? Do I have to be concerned about it? Does it affect fertility when the kid becomes adult?

3. They are saying that around 20% of the patients will experience decreased testicular size due to pediatric hernia surgery. Is it true? Will it impact someone to father a child when they become adult? My son goes to pediatric visit every year and pediatrician checks testicles and never said anything about testicle size.

4. I read in another article that if one sibling has hernia there is a possibility for other to get it. My younger son is 2 and he is healthy, Full term baby. I read in the below article that processus vaginalis is completely closed by 2 years (Reference: WWW.WWWW.WW ). Does this mean that the risk of getting indirect inguinal hernia is minimal or none for my younger son? Does he still have the risk of getting indirect inguinal hernia? Should I be concerned about it?

5. Is there any reason to be concerned about the fertility of my elder son due to this Pediatric Hernia surgery?

I apologize for asking these questions. I thought a lot about whether to ask these questions or not. I want to clear up for my peace of mind. Thanks a lot for answering these questions.

Posted Thu, 25 Apr 2013 in Medicines and Side Effects
 
 
Answered by Dr. Rohan Khandelwal 37 minutes later
Dear Sir,

I can understand that as a concerned parent these situations do create some anxiety but let me reassure you that inguinal hernia surgery is a very safe procedure with minimal risks. As far as your questions are concerned, I will answer them one by one.
1. Vas injury is an extremely rare complication of this surgery and in majority of the cases (90-95%) this surgery does not affect the sperm counts. If there is injury to one of the vas, although the chances of becoming a father go down slightly but almost 50-70% patients with a single testis and vas can become fathers.
2. Those antibodies are only formed if there is injury to the testis and this takes place in patients with an undescended testis, which was not the case with your child.
3. Again those patients with undescended testis and a hernia have the complication of a smaller testicular size. You should not worry about this complication in your child.
4. If your younger son is 2 years old and has not developed the problem as yet, it is very unlikely that he has a congenital hernia. The chances of him developing an inguinal hernia when he grows up are the same as the general population.
5. There is no reason to be concerned about his fertility if the surgeon is saying that the surgery was successful.

I hope I have answered your queries. Please feel to clarify any other query.
Above answer was peer-reviewed by
 
Follow-up: Had bilateral inguinal hernia surgery done. Will this affect fertility? Should I be concerned? 1 hour later
Thanks a lot Dr XXXXXXX Khandelwal for your replies. I have one small question in your response to question 1. Will the sperm count reduce only in the cases of Vas injury during the hernia surgery or does it have any other cause? If it is only due to Vas injury, I'm good since you confirmed that injury to vas is a very rare scenario. Thanks again for your prompt answers.
 
 
Answered by Dr. Rohan Khandelwal 4 minutes later
Dear Sir,

Injury to the vas (which is a tube which conducts the sperms) does not lead to reduction in the sperm production. It can lead to reduced counts on sperm analysis because the passage might be blocked but the sperm production is not hampered. Nowadays, there are methods to removed these blockages as well.

If there is any other query, please feel free to clarify.
Above answer was peer-reviewed by
 
Follow-up: Had bilateral inguinal hernia surgery done. Will this affect fertility? Should I be concerned? 5 hours later
Thanks a lot Dr XXXXXXX Khandelwal. I'm glad I contacted you since now I'm happy knowing that I worried unnecessarily. I want to make sure that I understand your response to question 1 fully before closing this discussion. I apologize for asking this again. In your response to question 1, you mentioned - ' in majority of the cases (90-95%) this surgery does not affect the sperm counts'. What affects the sperm count in the pediatric hernia surgery (Since it occurs in 10% of the cases)? Do I need to be concerned about this? I don't have any other questions. I'm good.THANK YOU for answering these questions!!!
 
 
Answered by Dr. Rohan Khandelwal 16 minutes later
Dear Sir,

If a pediatric hernia is associated with an undescended testis, then there are chances that the sperm count might be less due to two reasons. One is due to the incompletely developed testis and the other is injury to the testis during surgery. If the hernia is not associated with undescended testis, the chances of low sperm count are even less (1-5%).
In case of your child, there is no need to worry as the hernia was not associated with undescended testis.
Please feel free to clarify any other query.
Above answer was peer-reviewed by
 
Follow-up: Had bilateral inguinal hernia surgery done. Will this affect fertility? Should I be concerned? 3 days later
Thanks a lot Dr. XXXXXXX Khandelwal. I forgot to ask one final question. We observed that the scrotum of my elder son is slightly small compared to the boys of his age. During the pediatric visits, our pediatrician checks the testicles. She said his testicles are perfectly fine. I'm not sure whether there is any significance to the size of the scrotum? Does it affected due to Hernia surgery? Do we need to be concerned about the size of scrotum or is it normal? Thanks!!!
 
 
Answered by Dr. Rohan Khandelwal 3 minutes later
Dear Sir,

Testicular size is more important than the scrotal size. As the testis grow the scrotal size will also increase. Hernia surgery does not affect the scrotal size as the incision is made in the inguinal region. Please dont be concerned about the scrotal size. Let the pediatrician just monitor the testicular size. In case of any doubt, they can get a scrotal USG to see the testicular size and volume.

Please feel free to clarify any other query.
Above answer was peer-reviewed by
 
Follow-up: Had bilateral inguinal hernia surgery done. Will this affect fertility? Should I be concerned? 32 minutes later
Thanks a lot Dr. XXXXXXX Khandelwal. The only time I asked the pediatrician about the testicles is few months after the hernia surgery (When my elder son was 1 year old). She told me that she checked the testicles and they are perfectly fine. During the subsequent annual visits she examines the testicles and never expressed any concerns about testicles or scrotum.
 
 
Answered by Dr. Rohan Khandelwal 2 minutes later
Dear Sir,

I am sure the growth and the size would be normal, that is why she is not expressing any concerns about it. She would also be aware of this fact and would definitely let you know if something is not right.

Hoping for the best.
Above answer was peer-reviewed by
 
Follow-up: Had bilateral inguinal hernia surgery done. Will this affect fertility? Should I be concerned? 3 minutes later
Thanks a lot Dr. XXXXXXX Khandelwal. Thanks for everything and super fast responses. I'm relieved. Hereafter I will not worry about these things. Thanks again for excellent responses.
 
 
Answered by Dr. Rohan Khandelwal 2 minutes later
Dear Sir,

I am glad my replies could solve your queries.

Hoping for the best.
Above answer was peer-reviewed by
 
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