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

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.

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.

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.

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.