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Peer-reviewedCC BY-NC-NDBMC surgery

Beyond Recurrence: Impact of Surgical Technique on Testicular Microcirculation After Inguinal Hernia Repair.

  • Mehmet Emin Gönüllü1
  • Fatih Gürsoy2
  • İbrahim Feyyaz Naldemir3
  • Erman Yekenkurul2
  • Mehmet Fuat Çetin2
  • Sami Dogan2
  1. 1Bilecik Seyh Edebali University, Faculty of Medicine, Department of General Surgery, Bilecik, Türkiye. [email protected].
  2. 2Duzce University, Faculty of Medicine, Department of General Surgery, Duzce, Türkiye.
  3. 3Duzce University, Faculty of Medicine, Department of Radiology, Duzce, Türkiye.
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Abstract

Background

The impact of different inguinal hernia repair techniques on testicular perfusion remains a subject of clinical interest. While open and laparoscopic approaches demonstrate comparable outcomes in terms of recurrence and complications, their effects on testicular microcirculation are not fully elucidated.Methods

This retrospective comparative cohort study included 180 male patients who underwent unilateral primary inguinal hernia repair using open Lichtenstein, total extraperitoneal (TEP), or transabdominal preperitoneal (TAPP) techniques between January 2015 and December 2025 at a tertiary referral center. Doppler ultrasonography parameters, including resistive index (RI), peak systolic velocity (PSV), end-diastolic velocity (EDV), and testicular volume, were evaluated preoperatively, at postoperative day 7, and at 1 month. Changes over time and between groups were analyzed using multivariable regression and linear mixed-effects models. Subclinical testicular ischemia was defined based on predefined Doppler criteria.Results

Early postoperative changes in testicular perfusion parameters differed significantly between surgical techniques. At postoperative day 7, RI values were higher and EDV values were lower in the Lichtenstein group compared to TEP and TAPP (p < 0.001 and p = 0.002, respectively). These differences decreased at 1 month but remained statistically significant for RI (p = 0.003). Multivariable analysis demonstrated that surgical technique, operative time, and hernia sac size were independently associated with changes in RI. Subclinical testicular ischemia was more frequent in the Lichtenstein group, while laparoscopic approaches were associated with lower odds (TEP: OR 0.34, p = 0.002; TAPP: OR 0.41, p = 0.006). Longitudinal analysis confirmed a significant time-by-technique interaction for RI (p < 0.001), indicating partial recovery over time.Conclusion

Surgical technique is associated with transient alterations in testicular perfusion following inguinal hernia repair. Open Lichtenstein repair demonstrated more pronounced early microvascular changes, whereas laparoscopic techniques exhibited a more stable perfusion profile. These findings highlight the importance of surgical technique and intraoperative handling in preserving testicular microcirculation.

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Cite

BibTeXRIS
BibTeX
@article{gonullu2026beyond,
  title = {{Beyond Recurrence: Impact of Surgical Technique on Testicular Microcirculation After Inguinal Hernia Repair.}},
  author = {Mehmet Emin Gönüllü and Fatih Gürsoy and İbrahim Feyyaz Naldemir and Erman Yekenkurul and Mehmet Fuat Çetin and Sami Dogan},
  journal = {BMC surgery},
  year = {2026},
  month = jul,
  doi = {10.1186/s12893-026-04078-6},
  url = {https://europepmc.org/article/MED/42897582},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Beyond Recurrence: Impact of Surgical Technique on Testicular Microcirculation After Inguinal Hernia Repair.
AU  - Mehmet Emin Gönüllü
AU  - Fatih Gürsoy
AU  - İbrahim Feyyaz Naldemir
AU  - Erman Yekenkurul
AU  - Mehmet Fuat Çetin
AU  - Sami Dogan
PY  - 2026
DA  - 2026/07/01
JO  - BMC surgery
DO  - 10.1186/s12893-026-04078-6
UR  - https://europepmc.org/article/MED/42897582
AB  - Background  The impact of different inguinal hernia repair techniques on testicular perfusion remains a subject of clinical interest. While open and laparoscopic approaches demonstrate comparable outcomes in terms of recurrence and complications, their effects on testicular microcirculation are not fully elucidated.Methods  This retrospective comparative cohort study included 180 male patients who underwent unilateral primary inguinal hernia repair using open Lichtenstein, total extraperitoneal (TEP), or transabdominal preperitoneal (TAPP) techniques between January 2015 and December 2025 at a tertiary referral center. Doppler ultrasonography parameters, including resistive index (RI), peak systolic velocity (PSV), end-diastolic velocity (EDV), and testicular volume, were evaluated preoperatively, at postoperative day 7, and at 1 month. Changes over time and between groups were analyzed using multivariable regression and linear mixed-effects models. Subclinical testicular ischemia was defined based on predefined Doppler criteria.Results  Early postoperative changes in testicular perfusion parameters differed significantly between surgical techniques. At postoperative day 7, RI values were higher and EDV values were lower in the Lichtenstein group compared to TEP and TAPP (p < 0.001 and p = 0.002, respectively). These differences decreased at 1 month but remained statistically significant for RI (p = 0.003). Multivariable analysis demonstrated that surgical technique, operative time, and hernia sac size were independently associated with changes in RI. Subclinical testicular ischemia was more frequent in the Lichtenstein group, while laparoscopic approaches were associated with lower odds (TEP: OR 0.34, p = 0.002; TAPP: OR 0.41, p = 0.006). Longitudinal analysis confirmed a significant time-by-technique interaction for RI (p < 0.001), indicating partial recovery over time.Conclusion  Surgical technique is associated with transient alterations in testicular perfusion following inguinal hernia repair. Open Lichtenstein repair demonstrated more pronounced early microvascular changes, whereas laparoscopic techniques exhibited a more stable perfusion profile. These findings highlight the importance of surgical technique and intraoperative handling in preserving testicular microcirculation.
SN  - 1471-2482
ER  -