Testicular blood flow in patients with inguinal hernias before and after transabdominal preperitoneal hernioplasty

Background. The relevance of the topic is determined by the prevalence of the pathology, the objectives of improving quality of life in patients after inguinal hernioplasty, and the insufficient amount and low level of the evidence of the available data on the studied problem.
Objective: to study the condition of blood flow through the vessels of the spermatic cord in patients with inguinal hernias before and after transabdominal preperitoneal hernioplasty (TAPP).
Design and methods: The speed indicators of testicular blood flow were studied in 83 men with inguinal hernias before surgery and on the day 7 after TAPP. The speed indicators of arterial and venous blood flow were determined using the Toshiba aplio 500 device. The EHS classification was used, and the patients were divided into subgroups based on the method of endoprosthesis fixation. The first subgroup included 27 (32.5 %) patients with endoprosthesis fixation using the original method. The second group included 30 (36.1 %) patients with endoprosthesis fixation using an endostapler. The third subgroup consisted of 26 (31.3 %) patients who did not undergo endoprosthesis fixation. The data were processed using nonparametric statistical methods.
Results: Before the operation, arterial and venous blood flow disorders were detected in the vessels of the spermatic cord, which were most pronounced in recurrent hernias with a hernia opening diameter of more than 3 cm. Seven days after the operation, the increase in arterial linear blood flow was 56.4 %, and the increase in volumetric blood flow was 53.7 %. This was accompanied by a significant increase in venous outflow velocities. The best results were obtained in the subgroup with the original method of endoprosthesis fixation.
Conclusion: Recurrent inguinal hernias with a hernia ring diameter of more than 3 cm cause the most pronounced disorders of arterial and venous blood flow through the vessels of the spermatic cord. TAPP leads to a rapid and reliable restoration of the speed indicators of testicular blood flow to normal values, which improvemes in the reproductive health and quality of life of patients in the long-term postoperative period.

1. Oorzhak OV, Shost SYu, Mozes VG, et al. Inguinal hernia – epidemiology, risk factors, treatment methods (literature review). Acta biomedical scientica. 2021;6(4):230‒242. (In Russ.) https:// doi.org/10.29413/ABS.2021-6.4.21

2. Stabilini C, van Veenendaal N, Aasvang E, et al. Update of the international Hernia Surge guidelines for groin hernia management. BJS Open. 2023;7(5). https://doi.org/10.1093/bjsopen/zrad080

3. Gumenyuk SE, Gubish AV, Popov AYu, et al. Long-term results of various treatment options for ventral hernias. Kuban Scientific Medical Bulletin. 2017;1(2):61‒65. (In Russ.) https:// doi.org/10.25207/1608-6228-2017-2-61-65

4. Lazebnik LB, Golovanova EV, Volel BA, et al. Functional gastrointestinal disorders. Overlap syndrome. Clinical guidelines of the Russian scientific medical society of internal medicine and gastroenterological scientific society of Russia. Experimental and Clinical Gastroenterology. 2021;8(192):5‒117. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-192-8-5-117

5. Guseynova GT. Influence of various methods of hernia repair on the state of blood flow in the vessels of the spermatic cord and germination function of the testicle in men with inguinal hernias. Kazan medical journal. 2020;101(1):132–138. (In Russ.) https://doi.org/10.17816/KMJ2020-132

6. Magomedov MM, Magomedbekov RE. Various options of hernioplasty and their influence on reproductive health in men. Grekov’s Bulletin of Surgery. 2020;179(1):26‒30. (In Russ.) https://doi.org/10.24884/0042-4625-2020-179-1-26-30

7. Magomedov MM, Damadaev DM, Khamidov MA, Magomedov AA. Fertile potential in men with inguinal hernia and its dynamics in various treatment methods. Modern Problems of Science and Education. 2025;1. (In Russ.) https://doi.org/10.17513/spno.33886

8. Eurlings R, Killaars R, Visschers RGJ, van Gemert WG. Testicular vascularization after pediatric inguinal hernia repair: a systematic review and meta-analysis MDPI. Children. 2024;11(4):409. https://doi.org/10.3390/children11040409

9. Rancke-Madsen P, Öberg S, Rosenberg J. Mesh fixation in laparoscopic groin hernia repair: a comprehensive review of techniques and devices. Hernia. 2025;29(1):105. https://doi.org/10.1007/s10029-025-03276-0

10. Tigora A, Radu PA, Garofil DN, et al. Modern perspectives on inguinal hernia repair: a narrative review on surgical techniques, mesh selection and fixation strategies. J Clin Med. 2025;14(14):4875. https://doi.org/10.3390/jcm14144875

11. Lymar YuYu, Stavtsev ML, Supriyaga AA, Yudin VA. Postoperative outcomes in patients after modified inguinal reconstruction: An observational cohort study. Kuban Scientific Medical Bulletin. 2024;31(1):50‒63. (In Russ.) https://doi.org/10.25207/1608-6228-2024-31-1-50-63

12. Huerta S. Inguinal hernia repair in centers of excellence. Hernia. 2020;24:213–214. https://doi.org/10.1007/s10029-019-01998-6

13. Paasch C, Mainprize M. Who benefits from a shouldice repair? Hernia. 2024;28(6):2421‒2422. https://doi.org/10.1007/s10029-024-03159-w

14. Saeed J, Jamal Z, Siddiqui A, et al. Postoperative outcomes of the Desarda technique versus Lichtenstein mesh repair for inguinal hernias: A systematic review and meta-analysis. Cureus. 2025;17(9):e91388. https://doi.org/10.7759/cureus.91388

15. Andresen K, Rosenberg J. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2024;7(7):CD004703. https://doi.org/10.1002/14651858. CD004703.pub3

16. Giri A, Sharma AK, Mittal MK, et al. Study of testicular vascularity after totally extraperitoneal repair in inguinal hernia. International Surgery Journal. 2022;9(5):1012–1015. https://doi.org/10.18203/2349-2902.isj20221148

17. Popandopulo KI, Voskolupov AV, Bazlov SB, et al. Results of using a new method of mesh fixation during transabdominal preperitoneal inguinal hernia repair. Innovative Medicine of Kuban. 2025;10(1):17‒26. (In Russ.) https://doi.org/10.35401/2541-9897-2025-10-1-17-26