INNOVATIVE TECHNIQUES IN SPERMATIC CORD-SPARING HERNIOPLASTY (LITERATURE REVIEW)
Ключевые слова:
ingvinal churrasi, spermatik kanal, kanalni saqlovchi gerniyoplastika, minimal invaziv jarrohlik, to‘r innovatsiyasiАннотация
Inguinal hernia repair, a globally common procedure, has shifted its focus from minimizing recurrence to mitigating Chronic Postoperative Inguinal Pain (CPIP) and preserving the intricate neurovascular structures of the spermatic cord (SC). CPIP and reproductive system compromise, often stemming from surgical trauma, nerve entrapment, or mesh-induced inflammation, necessitate innovative strategies that prioritize SC integrity. This comprehensive review evaluates advancements across surgical approach, material science, and regenerative medicine designed to improve patient quality of life.
Analysis confirms that minimally invasive laparoscopic approaches (TAPP and TEP) consistently yield lower chronic pain rates than open mesh repair, primarily by reducing tissue trauma and dissection of the SC. Material innovations focus on lightweight and three-dimensional meshes, along with the adoption of atraumatic fixation techniques, such as bio-adhesives or non-fixation, to prevent nerve and cord compression. The most precise cord-sparing innovation is microsurgically assisted hernia repair, which uses high magnification for meticulous anatomical preservation, demonstrating superior outcomes regarding pain and vas deferens injury.
Emerging regenerative techniques include using biocompatible barrier membranes to shield the SC from the inflammatory effects of synthetic mesh, as well as developing dynamic scaffolds designed to promote de novo formation of muscle and nerve tissue, moving away from simple fibrotic reinforcement. Although conventional synthetic mesh remains the standard due to high recurrence rates associated with current biological materials, future perspectives necessitate robust clinical validation of these precision and regenerative methodologies to firmly establish truly cord-sparing hernioplasty standards.
Библиографические ссылки
1. Arrey, Eliel, Tatyana Young, and Aaron Alford. "A Comprehensive Review of the Evolution of Minimally Invasive Hernia Repair: Historical Milestones to Modern Clinical Practice." Current Surgery Reports 13.1 (2024): 2.
2. Olanrewaju, Olusegun A., et al. "Contemporary approaches to hernia repair: a narrative review in general surgery." Cureus 15.12 (2023).
3. Tigora, Anca, et al. "Modern perspectives on inguinal hernia repair: a narrative review on surgical techniques, mesh selection and fixation strategies." Journal of Clinical Medicine 14.14 (2025): 4875.
4. Romanowska, Monika, Tomasz Okniński, and Jacek Pawlak. "Modern materials applied in hernioplasty." Polish Journal of Surgery 88.4 (2016): 226-231.
5. Amato, Giuseppe, et al. "Massive Neomyogenesis in the Dynamic Regenerative Scaffold of the Stenting & Shielding Hernia System for Abdominal Hernioplasty. The Evidences in Experimental Porcine Model." (2024).
6. Di Nicola, Valerio, and Mauro Di Pietrantonio. "Regenerative Surgery for Inguinal Hernia Repair." Clin Res Trials 6 (2020): 1-8.
7. Anestiadou, Elissavet, et al. "Platelet-rich therapies in hernia repair: a comprehensive review of the impact of platelet concentrates on mesh integration in hernia management." Biomolecules 14.8 (2024): 921.
8. Di Nicola, V. "Regenerative Surgery in Open Mesh Repair for Inguinal Hernia." J Regen Med doi: 10.37532/jrgm. 2020.9 (1) 157 (2020): 2.
9. Amato, Giuseppe, et al. "A New Paradigm in Abdominal Hernioplasty: The Stenting & Shielding Hernia System Activates Tissue Growth Factors and Regenerates the Abdominal Muscle Barrier." (2024).
10. Amato, Giuseppe, et al. "The Regenerative Scaffold Stenting & Shielding Hernia System for Abdominal Hernioplasty Promotes Extensive Neo-Angiogenesis in an Experimental Porcine Model." (2024).
11. Graham, Danielle S., Ian T. MacQueen, and David C. Chen. "Inguinal neuroanatomy: implications for prevention of chronic postinguinal hernia pain." International Journal of Abdominal Wall and Hernia Surgery 1.1 (2018): 1-8.
12. Moseholm, Viktor Bay, Jason Joe Baker, and Jacob Rosenberg. "Nerve identification during open inguinal hernia repair: a systematic review and meta-analyses." Langenbeck's Archives of Surgery 408.1 (2023): 417.
13. Falzone, Umberto, et al. "Inguinal hernia repair: comparison between nerve sparing and neurectomy techniques." EUROMEDITERRANEAN BIOMEDICAL JOURNAL 19.16 (2024): 78-85.
14. Tropp, Joshua. "Biomaterial platforms offer capability of efficacious male contraceptives." (2022): 649-650.
15. Horvath-Pereira, Bianca de Oliveira, et al. "Biomaterials for Testicular Bioengineering: How far have we come and where do we have to go?." Frontiers in Endocrinology 14 (2023): 1085872.
16. Claure, Isabella, et al. "Biomaterials and contraception: promises and pitfalls." Annals of biomedical engineering 48.7 (2020): 2113-2131.
17. Liu, Zifan, et al. "Protective effectiveness of electrospinning fibrous membrane in inguinal hernia repair." Materials & Design 231 (2023): 112074.
18. Özant, Ali, and Kalbim Arslan. "Synthetic Meshes in Hernia Surgery." Cyprus Journal of Medical Sciences (2023).
19. Musters, G. D., et al. "Is there a place for a biological mesh in perineal hernia repair?." Hernia 20.5 (2016): 747-754.
20. Antoniadi, Evangelia, et al. "Innovative Strategies in Hernia Mesh Design: Materials, Mechanics, and Modeling." Materials 18.15 (2025): 3509.
21. Köckerling, F., et al. "What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction?." Hernia 22.2 (2018): 249-269.
22. Seefeldt, C. S., et al. "BIOLAP: biological versus synthetic mesh in laparo-endoscopic inguinal hernia repair: study protocol for a randomized, multicenter, self-controlled clinical trial." Trials 20.1 (2019): 55.
23. Seefeldt, Claudia Simone, et al. "Biological vs synthetic mesh in laparoendoscopic inguinal hernia repair: the BIOLAP randomized clinical trial." JAMA surgery (2025).
24. Romano, Candela, et al. "Comparative outcomes of synthetic and biological mesh use in laparoscopic inguinal hernia repair: a systematic review and meta-analysis." BMC surgery 25.1 (2025): 458.
25. Rutegård, Martin, et al. "Chronic pain, discomfort, quality of life and impact on sex life after open inguinal hernia mesh repair: an expertise-based randomized clinical trial comparing lightweight and heavyweight mesh." Hernia 22.3 (2018): 411-418.
26. Melkemichel, M., et al. "Patient-reported chronic pain after open inguinal hernia repair with lightweight or heavyweight mesh: a prospective, patient-reported outcomes study." Journal of British Surgery 107.12 (2020): 1659-1666.
27. Rutegård, Martin, et al. "Chronic pain after open inguinal hernia repair: expertise-based randomized clinical trial of heavyweight or lightweight mesh." British journal of surgery 108.2 (2021): 138-144.
28. Shah, S., and S. M. Shah. "A Study of comparison of light weight 3D polyester mesh vs. light polypropylene mesh in laparoscopic inguinal hernia repair." Clin Surg. 2019; 4 2405 (2019).
29. Tiwari, P., J. Lankar, and P. K. Reddy. "Contoured 3D mesh in laparoscopic inguinal hernia repair: does it reduce inguinodynia." MOJ Surg 3.4 (2016): 97-103.
30. Anh, Vu Hoai, Tran Manh Thang, and Huynh Tan Ai. "Evaluation of outcomes of totally extraperitoneal laparoscopic repair using 2D and 3D mesh in the treatment of direct inguinal hernia." Tạp chí Khoa học tiêu hóa Việt Nam 13.79 (2025).
31. Omarov, Nail, Elnur Huseynov, and Ayşegül Bahar Özocak. "Comparison of three-dimensional mesh (3D mesh) without fixation versus polypropylene mesh with fixation in patients of inguinal hernia undergoing totally extraperitoneal repair." Laparoscopic Endoscopic Surgical Science 31.2 (2024): 50.
32. Rashid, Tajamul, et al. "A comparative study of three-dimensional mesh (3D mesh) and polypropylene mesh in laparoscopic inguinal hernia repairs in adults." Int Surg J 5.1 (2018): 174-180.
33. Mir, Iqbal Saleem, et al. "An experience of short-term results of laparoscopic inguinal hernioplasty using 3D mesh in a developing country." International Journal of clinical medicine 6.01 (2015): 64-69.
34. Wei, Feng Xian, et al. "Transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) for laparoscopic hernia repair: a meta-analysis." Surgical Laparoscopy Endoscopy & Percutaneous Techniques 25.5 (2015): 375-383.
35. Öcal, İbrahim Halil, Burak Veli Ülger, and Mustafa Öcal. "Comparison of TAPP and TEP in laparoscopic inguinal hernia repair." Journal of Health Sciences and Medicine 7.2 (2024): 174-179.
36. Ozel, Yahya, Yalcin Burak Kara, and Yalçın Burak Kara. "Comparison of clinical outcomes of laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernia repair: A retrospective study." Cureus 16.9 (2024).
37. Felix, Edward, and Christiano Claus. "Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair." Hernia Surgery: Current Principles. Springer Nature Switzerland, 2025. 563-571.
38. Bracale, Umberto, et al. "Achieving the learning curve in laparoscopic inguinal hernia repair by tapp: a quality improvement study." Journal of Investigative Surgery 32.8 (2019): 738-745.
39. Usmani, F., et al. "Effect of direct defect closure during laparoscopic inguinal hernia repair (“TEP/TAPP plus” technique) on post-operative outcomes." Hernia 24.1 (2020): 167-171.
40. Hidalgo, Nils Jimmy, et al. "Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP)." BMC surgery 23.1 (2023): 270.
41. Vãrcuæ, Flore, et al. "Laparoscopic repair of inguinal hernia TEP versus TAPP." Chirurgia 111 (2016): 308-312.
42. Chibata, Maurício, and Oona Tomiê Daronch. "Assessment of postoperative risk of complications on inguinal hernioplasty and its relation to risk factors." Revista da Associação Médica Brasileira 66.5 (2020): 623-629.
43. Ece, İlhan, and Hüseyin Yılmaz. "An overlooked complication of the inguinal hernia repair: Dysejaculation." Turkish journal of surgery 34.1 (2018): 1.
44. Olsson, A., et al. "Do postoperative complications correlate to chronic pain following inguinal hernia repair? A prospective cohort study from the Swedish Hernia Register." Hernia 27.1 (2023): 21-29.
45. Dai, W., et al. "Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study." Hernia 23.2 (2019): 267-276.
46. Weyhe, Dirk, et al. "Risk factors for perioperative complications in inguinal hernia repair–a systematic review." Innovative surgical sciences 2.2 (2017): 47-52.
47. Olsson, Anders, et al. "Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair." Surgery 161.2 (2017): 509-516.
48. Messias, Bruno Amantini, et al. "The Lichtenstein technique is being used adequately in inguinal hernia repair: national analysis and review of the surgical technique." Revista do Colégio Brasileiro de Cirurgiões 50 (2023): e20233655.
49. Lange, J. F. M., et al. "The role of surgical expertise with regard to chronic postoperative inguinal pain (CPIP) after Lichtenstein correction of inguinal hernia: a systematic review." Hernia 20.3 (2016): 349-356.
50. Kamani, Fereshteh, et al. "Modified Lichtenstein hernioplasty with concomitant tissue repair: a retrospective study on postoperative chronic pain." BMC surgery 24.1 (2024): 222.
51. Messias, Bruno Amantini, et al. "Lichtenstein technique for inguinal hernia repair: ten recommendations to optimize surgical outcomes." Hernia 28.4 (2024): 1467-1476.
52. Lillo-Albert, Guillermo, et al. "Chronic inguinal pain post-hernioplasty. Laparo-endoscopic surgery vs lichtenstein repair: systematic review and meta-analysis." Hernia 28.4 (2024): 1427-1439.
53. Hu, Qiang, et al. "Efficacy and safety of ilioinguinal neurectomy in open tension-free inguinal hernia repair: A meta-analysis of randomized controlled trials." The American Journal of Surgery 226.4 (2023): 531-541.
54. Shah, Mohammed Yunus, et al. "Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study." Medicine 101.26 (2022): e29746.
55. Wani, Mumtaz Ud Din, et al. "A comparative study of skin staples versus sutures for fixing mesh in tension-free mesh hernioplasty." Arch Clin Exp Surg 7 (2018): 7-12.
56. Talha, Ahmed, Ahmed Shaaban, and Rabie Ramadan. "Preperitoneal versus Lichtenstein tension-free hernioplasty for the treatment of bilateral inguinal hernia." The Egyptian Journal of Surgery 34.2 (2015).
57. Yenli, Edwin MT, et al. "Our experience with the use of low cost mesh in tension-free inguinal hernioplasty in Northern Ghana." Ghana Medical Journal 51.2 (2017): 78.
58. Zhao, Xin, et al. "Tension-free hernioplasty is better than traditional herniorrhaphy for pediatric inguinal hernias." Int J Clin Exp Med 12.5 (2019): 5703-5709.
59. Henriksen, Nadia A. "Systemic and local collagen turnover in hernia patients." Dan Med J 63.7 (2016): B5265.
60. Burcharth, Jakob, et al. "Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies." Surgical innovation 22.3 (2015): 303-317.
61. Scheuermann, Uwe, et al. "Transabdominal Preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair–A systematic review and meta-analysis of randomized controlled trials." BMC surgery 17.1 (2017): 55.
62. Reinpold, Wolfgang. "Risk factors of chronic pain after inguinal hernia repair: a systematic review." Innovative surgical sciences 2.2 (2017): 61-68.
63. Köckerling, Ferdinand, and Maarten P. Simons. "Current concepts of inguinal hernia repair." Visceral medicine 34.2 (2018): 145-150.
64. Negri, Luciano, et al. "Influence of inguinal hernia repair on sperm autoimmunity: The largest single center experience." Andrology 10.1 (2022): 105-110.
65. Schulster, Michael L., et al. "Microsurgically assisted inguinal hernia repair and simultaneous male fertility procedures: rationale, technique and outcomes." The Journal of Urology 198.5 (2017): 1168-1174.
66. Firoozabadi, Reza, Paul Stafford, and Milton Routt. "Risk of spermatic cord injury during anterior pelvic ring and acetabular surgery: an anatomical study." Archives of Bone and Joint Surgery 3.4 (2015): 269.
67. Dagur, Gautam, et al. "Neoplastic diseases of the spermatic cord: an overview of pathological features, evaluation, and management." Translational Andrology and Urology 6.1 (2017): 101.
68. Dai, Yidan, et al. "The distribution of nerves supplying the testis, epididymis and accessory sex glands of Suncus murinus." Anatomical Science International 94.1 (2019): 128-135.
69. Huang, Shoujiang, et al. "Effect of inguinal hernia on the thickness and blood flow of spermatic cord in boys." World Journal of Pediatric Surgery 2.2 (2019): e000030.
70. Collinge, Cory A., and Michael J. Beltran. "Anatomic relationship between the spermatic cord and the pubic tubercle: are our clamps injuring the cord during symphyseal repair?." Journal of Orthopaedic Trauma 29.6 (2015): 290-294.
71. Yang, Yu, et al. "Microstructures of the spermatic cord with three-dimensional reconstruction of sections of the cord and application to varicocele." Systems Biology in Reproductive Medicine 66.3 (2020): 216-222.
72. Oka, Shintaro, Koji Shiraishi, and Hideyasu Matsuyama. "Microsurgical anatomy of the spermatic cord and spermatic fascia: distribution of lymphatics, and sensory and autonomic nerves." The Journal of Urology 195.6 (2016): 1841-1847.
73. Özsağır, Yusuf Önder, et al. "A rare complication after inguinal hernia repair: testicular torsion." The European Research Journal 5.1 (2018): 209-212.
74. Blair, A. B., et al. "Postoperative urinary retention after inguinal hernia repair: a single institution experience." Hernia 21.6 (2017): 895-900.
75. de Goede, Barry, et al. "Risk factors for inguinal hernia in middle-aged and elderly men: results from the Rotterdam Study." Surgery 157.3 (2015): 540-546.
76. Cowan, B., et al. "Risk factors for inguinal hernia repair among US adults." Hernia 27.6 (2023): 1507-1514.
77. Öberg, Stina, Kristoffer Andresen, and Jacob Rosenberg. "Etiology of inguinal hernias: a comprehensive review." Frontiers in surgery 4 (2017): 52.
78. Abebe, Melese Shenkut, et al. "Worldwide magnitude of inguinal hernia: Systematic review and meta-analysis of population-based studies." SAGE Open Medicine 10 (2022): 20503121221139150.
79. Aljubairy, Abdullah Mohammed, et al. "Prevalence of inguinal hernia in relation to various risk factors." EC Microbiology 9.5 (2017): 182-192.
