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American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 46-53 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

 

 

 

 

 

 

 

 

ABSTRACT 

Analysis of the results of treatment of inguinal hernias using endovideosurgical hernioplasty: TAPP, TEP and e-TEP in 

216 patients was carried out. Total extraperitoneal hernioplasty (TER) is preferable for patients who have undergone 

operations on the abdominal cavity and pelvic organs due to the adhesion process. TARR is recommended when it is 

necessary to perform simultaneous operations and in case of bilateral localization of hernias.  It made it possible to 

reduce the number of hematomas (in the TARR groups from 8.6% to 3.7%, in the TER-e-TER groups from 7.6% to 5.7%) 

and seromas (in the TARR groups from 8.6% to 7.4%, in the TER-e-TER groups from 13.5% to 5.7%) with dissection in the 

preperitoneal space. 

KEYWORDS 

Inguinal hernia, endovideosurgical hernioplasty. 

INTRODUCTION

A significant number of existing methods of hernia 

repair has become the basis for a huge number of 

studies comparing the effectiveness of various 

techniques. At the moment, however, there is no 

irreproachable way to perform surgery to remove an 

inguinal hernia. Tension methods of hernioplasty are 

losing ground today, and among the non-tension 

methods using a mesh allograft, endosurgical 

  Research Article 

 

RESULTS OF ENDOVIDEOSURGERY FOR INGUINAL HERNIA 
 

Submission Date: Sep 20, 2024, Accepted Date:  Sep 25, 2024,  

Published Date: Sep 30, 2024  

Crossref doi: https://doi.org/10.37547/ajbspi/Volume04Issue09-04 

 

 

Kamalov N.A. 
Samarkand State Medical University, Uzbekistan 

 

Babazhanov A.S. 
Samarkand State Medical University, Uzbekistan 

 

 

 

 

Journal Website: 

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com/index.php/ajbspi 

Copyright: Original 

content from this work 

may be used under the 

terms of the creative 

commons attributes 

4.0 licence. 

 

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Volume 04 Issue 09-2024 47 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 46-53 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

techniques are gaining the palm, among which TAPP 

(transabdominal preperitoneal hernia repair) and TEP 

(totally extraperitoneal hernia repair) surgical 

interventions stand out favorably [1,3]. Their 

advantage, in addition to low invasiveness, is that the 

implant is placed extraperitoneally and, accordingly, 

does not have contact with the abdominal organs. This 

sharply reduces the likelihood of the formation of 

postoperative adhesions and peritoneal adhesions. In 

the case of the use of TARR, which involves the use of 

transabdominal access, there is a risk of injury to the 

abdominal organs during surgery, especially in the case 

of previous laparotomy. TER is devoid of this 

drawback, since during the surgical intervention there 

is no entrance to the abdominal cavity, and all 

manipulations take place in the preperitoneal space. 

However, this type of surgical intervention is 

characterized by a small surgical space, which requires 

a higher qualification of the operating surgeon[2,6]. 

Along with this, additional problems during TER may 

occur in the case of previous prostate surgeries due to 

the scarring process in the preperitoneal tissue [4,5]. 

Also, TER is not considered as a surgical treatment of 

bilateral inguinal hernias. Improvement of the TER 

technique by J. Daes (2010) was implemented in e-TER 

(extended totally extraperitoneal hernia repair), which 

made it possible to perform effective surgical 

interventions for bilateral, strangulated and inguinal 

hernias of large sizes. 

Thus, the variety of endovideosurgical methods of 

hernioplasty determines the need for their further 

study in order to form the most favorable surgical 

method of surgical intervention. 

Objective. To analyze the results of TARR and TER 

endovideosurgical hernioplasty to determine the 

indications and conditions for their implementation 

and to identify shortcomings. 

METHODS  

The basis of this study is the analysis of the results of 

treatment of inguinal hernias using endovideosurgical 

hernioplasty: TARR, TER and e-TER in 216 patients 

operated in the Department of Endoscopic Surgery of 

Samarkand GMO No1 for 8 years (2017-2024). 

All of them were hospitalized for planned surgical 

treatment. In accordance with the tasks, the patients 

were divided into 2 groups. Retrospective groups 

included 110 patients who underwent the following 

patients: - TARR hernioplasty – 58 patients; - TER 

hernioplasty – 52 patients. 

Prospective groups included 106 patients who 

underwent the following patients: - TARR hernioplasty 

– 54 patients; - e-TER hernioplasty – 52 patients. 

Among the patients, men of middle and older age 

groups prevailed, which is characteristic of inguinal 

hernias. All hospitalized patients were diagnosed with 

primary uni- or bilateral inguinal hernias of I, II or III (A 

or B) types (according to Nyhus). In the retrospective 

groups, inguinal hernias were most often found in Type 

II (oblique with an expanded ring) and Type IIIA 

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Volume 04 Issue 09-2024 48 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 46-53 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

(straight). At the same time, among those operated 

using the TARR techniques, there were more patients 

with complex types of hernias (Type IIIA and Type IIIB). 

Bilateral hernias (Type IIIA) were observed in 4 (3.6%) 

patients, and all of them were operated using the TARR 

technique. 

This study involved patients who had previously 

undergone surgical treatment. In the TARR group, 

these were 10 (17.2%) patients, and in the TER group – 

11 (21.2%). The most common is an open-access 

appendectomy in the right iliac region. 

In the prospective groups, inguinal hernias of types II 

and IIIA were most common in 77 (72.6%) patients. 

From these, more patients with direct hernias (Type 

IIIA) were operated using the e-TER technique: 40.4% 

compared to 33.3% among those, who were operated 

using the TARR technique. At the same time, the group 

of patients operated using the TARR technique 

included 3 (4.6%) patients with concomitant 

cholelithiasis, chronic calculous cholecystitis, who 

underwent simultaneous surgical interventions: 

hernioplasty + cholecystectomy. Patients with type IIIB 

hernias, which included sliding and inguinal-scrotal 

hernias, were more often operated on by the e-TER 

method: 17.3% versus 5.6% in the TARR group. Patients 

hospitalized with bilateral direct hernias (Type IIIA) 

were also more likely to be operated on by extended 

full extraperitoneal hernioplasty (5 (9.6%) patients. 

Patients with an operative history were much more 

likely operated using the e-TER technique. Thus, 

among all patients in whom e-TER was used (n=52), 15 

(28.8%) had previously undergone abdominal surgery. 

In the TARR group (n=54), there were 6 such patients 

(10.1%), and all previous surgical interventions were 

performed by endovideosurgery.  

Ultrasound scanning has found its wide use in 

instrumental diagnostics of PG. The thickness of the 

oblique abdominal muscles in patients with PG was 

significantly less in comparison with healthy 

individuals. 

  
Figure 1. Criteria for the width of the 

oblique abdominal muscles (rectus and 
internal) in patients with inguinal hernia 

Figure 2. Ultrasound picture of the muscles 
of the inguinal region in a patient with 

inguinal hernia 

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Volume 04 Issue 09-2024 49 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 46-53 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

Muscle thickness indicators during tension in patients 

with PG changed by 0.192±0.101 cm on average, while 

in the group of healthy individuals the change in this 

indicator was more significant – by 1.186±0.109.  

Consequently, in patients with PH, in contrast to 

healthy people, a decrease in the width of the oblique 

abdominal muscles is impaired by muscle tension, 

which, in fact, is considered a predisposing factor for 

destructive changes in the tissues of the aponeurosis 

of the abdominal muscles and an increase in the size of 

the hernial defect that has arisen. 

As part of the exclusion of complications (seroma, 

hematoma) and possible migration of the mesh during 

the first few days after surgery, all patients underwent 

ultrasound scanning. Small hematomas and seromas 

(volume up to 20 ml) were subjected to conservative 

treatment, large ones (volume more than 20 ml) were 

punctured under ultrasound control.  

RESULTS AND DISCUSSION 

Analysis of the treatment of patients in retrospective 

groups showed the following results. The average 

duration of surgical interventions was 82.3±15.2 

minutes with the TARR method, and 79.1±13.4 minutes 

with the TER method (p>0.05).  

The total number of complications registered in both 

groups was 12 (10.9%) cases. Intraoperative 

complications were more common in the TER group 

(13.4% versus 8.6% in the TARR group). In the group of 

patients operated using the TARR technique, in 5.2% of 

cases, damage to internal organs occurred at the stage 

of the first trocar placement. All of these patients had 

previously undergone abdominal surgery. Such a 

complication was not noted in the TER group, since the 

technique did not imply entry into the abdominal 

cavity. The most common intraoperative complication 

of TER surgery was damage to the parietal peritoneum 

during dissection in the preperitoneal space. The 

developed pneumoperitoneum did not allow 

continuing the operation by the TEP method. 

Conversion was carried out - the transition to TARR. 

This option has also been classified as an intraoperative 

complication. Damage to the epigastric vessels was 

slightly more common with the TARR technique (3.4% 

versus 1.9% with TEP). 

The incidence of postoperative complications did not 

differ statistically significantly in the TARR and TER 

groups, amounting to 31.0% and 30.8%, respectively 

(p>0.05). At the same time, most of the complications 

did not have significant consequences. Seromas and 

hematomas in both groups were treated 

conservatively with a positive effect. In 3 cases, their 

evacuation by puncture method under ultrasound 

guidance was required. Mesh migration, which was 

observed in 2 (3.4%) cases in the TARR group and in 1 

(1.9%) case in the TEP group.  

Long-term results of ECH hernioplasty were traced in 

84 (76.4%) patients of retrospective groups. 43 (74.1%) 

patients after TARR hernioplasty and 41 (78.8%) 

patients operated on by TER answered the 

questionnaire. The duration of postoperative follow-

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Volume 04 Issue 09-2024 50 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 46-53 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

up averaged 19.4±3.9 months. Recurrent inguinal 

hernia was detected in 1 (2.3%) patient from the TARR 

group and in 1 (2.4%) patient from the TER group.  

The prospective study is based on treatment outcomes 

from 106 patients. Of these, 54 patients were operated 

on using the TARR technique, and 52 using the e-TER 

technique.  

The TARR operation was performed under 

endotracheal anesthesia with mechanical ventilation. 

The technique of transabdominal preperitoneal 

hernioplasty pursues the main task of eliminating a 

hernial defect on the abdominal side, which is achieved 

by placing a mesh implant on the posterior wall of the 

inguinal canal, due to which it is strengthened (Fig. 3, 

4). 

 

  
Figure 3. - Fixation of the mesh endoprosthesis Figure 4. - Final stage. Peritonization of the 

endoprosthesis 

 

A feature of full extraperitoneal e-TER hernioplasty is 

that the entrance to the abdominal cavity is not 

performed, and all manipulations take place in the 

space created outside it (Fig. 5, 6).  

 

  
Figure 5 - Dissection in the 

extraperitoneal space 

Drawing. 6. The mesh implant is placed 

in the preperitoneal space 

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Volume 04 Issue 09-2024 51 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 46-53 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

The mean duration of e-TER hernioplasty was 

significantly shorter than that of TARP (59.7±12.1 versus 

65.2±13.5 minutes (p<0.05). 

The total number of intraoperative complications was 

significantly lower (p<0.05) with e-TER surgery (3.8% 

versus 5.5% with TARD). At the same time, most 

complications from the e-TER group relate to damage 

to the parietal peritoneum, which is less significant 

than damage to the abdominal cavity organs or 

epigastric vessels that occurred in TARR. In the group 

of patients operated on using the TARR technique, 

compared to the retrospective group of TARR, the 

number of abdominal organ injuries decreased from 

5.2% to 3.7%. This decrease is explained by the fact that 

similar injuries occurred in patients who had previously 

undergone abdominal surgery. There was also a 

decrease in the incidence of epigastric vascular injury 

in the prospective groups compared to retrospective 

groups. At the same time, the difference in the TARR 

groups was not statistically significant (p>0.05), in 

contrast to the TER and e-TER groups, where the 

reduction in the incidence of this intraoperative 

complication is statistically significant (p<0.05). 

The most common postoperative complications were 

the formation of seromas and hematomas in the area 

of the mesh implant, and if the frequency of 

hematomas in the groups did not have statistically 

significant differences (p>0.05), then seromas were 

more common in e-TER hernioplasty, which may be 

due to a large volume of dissection in the preperitoneal 

tissue. The rate of mesh migration in the immediate 

postoperative period was slightly less common in the 

e-TER group of 1.9% versus 3.7% in the TARP group, 

although these differences were not statistically 

significant (p>0.05). 

At the same time, it should be emphasized that only 

self-fixing mesh implants were used in e-TER 

hernioplasty, and stapler mesh fixation was used in 

TARR. The frequency of superficial suppuration also 

did not have statistically significant differences 

between the groups. The incidence of infection in the 

mesh area did not differ significantly in the TARP and e-

TER groups. 

Long-term results of ECC hernioplasty in prospective 

groups were observed in 91 (85.8%) patients within 10 

to 32 months (average 17.2±3.8 months) after surgery. 

Of these, 47 (51.6%) patients were operated on using 

the TARR technique, and 44 (48.4%) patients with the 

e-TER method. Recurrence of hernia was detected in 1 

(2.1%) patient from the TARR group, recurrence was 

not detected in the e-TER group. 

The main advantages of the e-TER method are its 

greater effectiveness and safety compared to the 

TARR technique in cases of previous surgical 

interventions on the abdominal cavity and pelvic 

organs. Along with this, the TARR method makes it 

possible to perform simultaneous surgical 

interventions, which was shown by the example of 

patients with concomitant cholelithiasis, chronic 

calculous cholecystitis. Bilateral hernias can be 

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Volume 04 Issue 09-2024 52 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 46-53 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

successfully operated by the usage of any techniques. 

Also, much depends on the experience and 

preferences of the operating surgeon. If there are 

contraindications to general anesthesia, which is 

necessary for TARR hernia repair, the e-TER technique, 

which can be performed under regional anesthesia, 

can be the operation of choice. 

CONCLUSIONS 

1. Endovideosurgical transabdominal preperitoneal 

(TARR) inguinal hernioplasty was accompanied by 

abdominal organ injuries in 5.2%, which was excluded 

with total extraperitoneal (e-TER) plasty. However, 

due to technical difficulties due to space constraints of 

3.8%, the TER has been converted to TARR. 

2. Total extraperitoneal hernioplasty (TER) is 

preferable in patients who have undergone abdominal 

and pelvic surgery due to adhesions. TARR is 

recommended when it is necessary to perform 

simultaneous operations and in case of bilateral 

localization of hernias. 

3. The algorithm for choosing the method of 

endovideosurgical operations for inguinal hernias, 

based on taking into account the advantages and 

disadvantages of TARR and TER, made it possible to 

achieve a higher level of quality of treatment, made it 

possible to reduce the number of hematomas (in the 

TARR groups from 8.6% to 3.7%, in the TER-e-TER 

groups from 7.6% to 5.7%) and gray (in the TARR groups 

from 8.6% to 7.4%, in the TER-e-TER groups from 13.5% 

to 5.7%) in the dissection in the preperitoneal space. 

4. The incidence of hernia recurrence in the TARR and 

e-TER groups with a mean postoperative follow-up 

period of 17.2±3.8 months in TARR was 2.1% with 

recurrence leveling in e-TER. In the retrospective TARR 

and TER groups, the incidence of hernia recurrence 

also did not have significant differences (2.3% and 2.4%, 

respectively), but it was higher than in the prospective 

study, which proves the clinical efficacy of 

endovideosurgical hernia repair of inguinal hernias 

with a differentiated approach to the choice of surgical 

method. 

REFERENCES 

1. Benedetti M, Albertario S, Niebel T, et al. - 

"Intestinal perforation as a long-term complication 

of plug and mesh inguinal hernioplasty: case 

report." Hernia, 2005.  

2. Köckerling F, Hantel E, Adolf D, Kuthe A, Lorenz R, 

Niebuhr H, et al. - "Differences in the outcomes of 

scrotal vs lateral vs medial inguinal hernias: a 

multivariable analysis of registry data." Hernia 

(2020).  

3. N Rodríguez Valenzuela, J Sánchez González, B 

Pérez Saborido - "Repair of Recurrent Inguinal 

Hernia After Endoscopic TEP Hernioplasty Through 

TAPP Approach." British Journal of Surgery, May 

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4. Sanders DL, Porter CS, Mitchell KC, Kingsnorth AN 

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https://doi.org/10.37547/ajbspi/Volume03Issue03-01
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Volume 04 Issue 09-2024 53 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 46-53 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

5. Yamamoto S, Kubota T, Abe T, et al. - "A rare case 

of mechanical bowel obstruction caused by mesh 

plug migration." Hernia, 2015. DOI: 

[10.1007/s10029-014-1247-

3](https://doi.org/10.1007/s10029-014-1247-3) 

6. Yilmaz I, Karakaş DO, Sucullu I, et al. - "A rare cause 

of mechanical bowel obstruction: mesh 

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