Erectile Function Before and After Elective Inguinal Hernia Repair: A Paired IIEF-5 Study Comparing Laparoscopic and Open Techniques

Objective: This study aimed to evaluate changes in erectile function, assessed using the International Index of Erectile Function-5 (IIEF-5), in male patients undergoing elective inguinal hernia repair and to compare outcomes according to surgical technique and hernia characteristics. Materials and Methods: A total of 126 male patients who underwent elective unilateral inguinal hernia repair using either laparoscopic transabdominal preperitoneal/totally extraperitoneal repair or open Lichtenstein repair were included. Patients with severe comorbid conditions that could affect erectile function or surgical outcomes were excluded. Preoperative erectile function was assessed using the IIEF-5 questionnaire during routine preoperative evaluation within one month before surgery, and postoperative assessment was performed using the same questionnaire at the sixth postoperative month. Routine tacker fixation was used in all laparoscopic procedures. Subgroup analyses were performed according to the presence of scrotal hernia, and independent predictors of postoperative change in IIEF-5 score were evaluated using multivariate linear regression analysis. Results: Laparoscopic repair was performed in 59 patients (46.8%), whereas 67 patients (53.2%) underwent open Lichtenstein repair. In the overall cohort, the mean IIEF-5 score increased from 22.85 ± 3.12 preoperatively to 23.35 ± 1.98 at the sixth postoperative month (p < 0.05). No significant difference in IIEF-5 score change was observed between laparoscopic and open repair groups (p > 0.05). Although the overall postoperative increase in IIEF-5 score was statistically significant, its magnitude was small. Patients with scrotal hernia showed a greater postoperative IIEF-5 score increase compared with those without scrotal hernia (p < 0.001), but this subgroup was small. In multivariate analysis, scrotal hernia status (β = +2.41; p = 0.041) and lower baseline IIEF-5 score (β = −0.425; p = 0.001) were associated with greater postoperative score increase. Conclusions: In this retrospective paired comparative study, erectile function was evaluated in male patients undergoing elective inguinal hernia repair using paired preoperative and sixth-month postoperative IIEF-5 scores. Erectile function appeared to be largely preserved after surgery, and the overall postoperative increase in IIEF-5 score was statistically significant but small in magnitude. No significant difference in IIEF-5 score change was observed between laparoscopic and open Lichtenstein repair. Scrotal hernia status and lower baseline IIEF-5 scores were associated with greater postoperative IIEF-5 score increase; however, this subgroup finding should be interpreted as exploratory and requires confirmation in larger prospective cohorts. These findings may help provide more realistic expectations during preoperative counseling, while avoiding causal interpretation.