




































CMI 03 (04), 372−377 
CMI JOURNAL 372 

 

 
 

Clinical Medicine Insights 
 

DOI:https://doi.org/10.52845/CMI/2023-4-1-2 

    CMI 04 (01), 372-377 (2023)                                                                                                                                                   
ISSN (O) 2694-4626

 

RESEARCH ARTICLE                                                                                                    

Inguinal Hernias Repair by Laparascopy.(Tep). 

Olga Caridad León González
1
, Pedro Rolando López Rodríguez2*, Lais Angélica 

Ceruto Ortiz
3
, Jorge Agustín Satorre Rocha

4
, Eduardo García Castillo

5
, Luis  Marrero  

Quiala
6
 

1
I Degree Specialist in General Surgery. Assistant Professor and Assistant Researcher. 

2
II Degree Specialist in General Surgery. Consulting Professor. Assistant Professor and Assistant 

Researcher. 

3
Resident of 3rd Year in General Surgery. Instructor teacher. 

4
First Degree Specialist in General Surgery. Assistant Professor. 

5
First Degree Specialist in General Surgery. Assistant teacher. 

6
First Degree Specialist in General Surgery.Assistant Professor 

Corresponding Author: Pedro Rolando López Rodríguez 

  

Introduction

Since the concept of endoscopic inguinal hernia 

repair was first described by Ger in 1982, 

endoscopic techniques have been modified; It was 

a time when failures and complications - coupled 

with high cost - outweighed initial enthusiasm. (1) 

Laparoscopic hernioplasty (LH) has gained 

popularity in the last decade and numerous 

controlled studies appear in the literature 

comparing laparoscopic techniques with 

conventional ones. (2) In recent years, HL, despite 

being one of the most controversial laparoscopic 

Abstract 

Introduction: The hernia affection is one of the processes that has been studied into much detail and whose 

treatment pursues excellence, although many controversies are still yet to be resolved. Laparoscopy repair of 

inguinal hernia is a treatment method that improves the quality of management given to our patients.  

Objective: To identify perioperative events, surgical complications and to evaluate the pain referred for the 

patients who have had inguinal hernia repair by the laparoscopic method. (TEP). 

Methods: A prospective and descriptive study was done on 80 patients who have had endoscopic 

(TEP)repair of inguinal hernias between January 2013 and December 2020.  

Results: We performed 100 hernioplastias by laparocoscopy in 80 patients. The male sex predominated in a 

5:1 ratio and the surgical time average was, 53.5 minutes for unilateral hernias and 71.3 minutes for 

the bilateral ones. The most frequent complication in the transoperatory stage was ¨minor bleeding¨. At 15 

days after surgery, 86.3%   of the operated did not complain of pain, but social and laboral reintegration was 

at a 34% of the total. 

Conclusions: Laparoscopic inguinal hernioplasty is a good therapeutic option, mainly in patients with 

bilateral and reproduced inguinal hernias. 

Keywords: laparoscopic hernioplasty, inguinal hernia, hernia recurrence. 

Copyright : © 2021 The Authors. Published by Medical Editor and Educational Research Publishers Ltd. 

This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/lic enses/by-

nc-nd/4.0/). 

https://doi.org/10.52845/CMI/2023-4-1-2
https://creativecommons.org/lic%20enses/by-nc-nd/4.0/
https://creativecommons.org/lic%20enses/by-nc-nd/4.0/


CMI 03 (04), 372−377 
CMI JOURNAL 373 

CMI  JOURNAL                                                              Pedro Rolando López Rodríguez et al. 

 

 
 

procedures, has established itself as a therapeutic 

option to consider. The advantages of this method 

are demonstrated in bilateral, recurrent hernias 

and in the labor-active subject, who requires early 

return to work. (3) 

Method 

Between January 2013 and December 2020, a 

prospective, descriptive, longitudinal-cut study 

was carried out in 80 patients operated on by 

endoscopy (PET) with the diagnosis of inguinal 

hernia, at the General Teaching Hospital "Enrique 

Cabrera". All patients who agreed with the type of 

surgical intervention, the study and who gave their 

informed consent were included; patients older 

than 30 years classified ASA I-III, without 

anesthetic contraindications for laparoscopic 

intervention and patients classified as Nyhus III 

and IV. Patients with previous surgical wounds in 

the inguinal region, to operate, not dependent on 

reproduced inguinal hernias and patients with 

complicated, irreducible or slipped inguinal 

hernias; they were excluded. The surgical 

techniques were: totally extraperitoneal 

laparoscopic inguinal hernioplasty (TEP). The 

PET technique was performed with some variants 

such as: no use of the balloon trocar, the 

preperitoneal space was decolorized by means of 

the 0º laparoscope and the insufflation of CO2 at 

13 mmHg. In patients with large hernial rings, a 

polypropylene cone was placed in the hernial 

defect and subsequently a 15 x 12 cm 

polypropylene prosthesis. There was no need to 

fasten the meshes with clips. (4) In the immediate 

postoperative period, the visual pain scale analog 

scale (VAS) was applied and a pain value was 

assigned by means of "little faces", which starts 

from very happy (I value) to very sad (X value). 

Pain quantification was repeated in consultation 7 

days, 15 days and one month after the operation. 

Results 

100 hernias were operated on in 80 patients (20 

patients [25%] had bilateral hernias, 85 primary 

hernias, and 15 reproduced hernias). The average 

age was 55.6 years, the youngest patient was 30 

years old and the oldest was 77 years old, but the 

majority (14 patients) belonged to the fifth decade 

of life. The male sex predominated in 84%, which 

represented a male / female ratio of 5: 1. 43% of 

the patients made great physical efforts on a 

regular basis. 

 

Table 1. Toxic habits and personal pathological history (APP). 

Toxic habits and (APP)         Frequency                  % 

Chronic  Cough                   6                  7,5 

  COPD                  4                  5,0 

 Constipation                  7                  8,7 

 Heart  disease                  7                  8,7 

 Diabetes  Mellitus                  7                  8,7 

  Smoking                 36                 45,0 

  Alcohol  consumption                 17                 21,2 

N= 80 COPD: Chronic obstructive pulmonary disease 

 

Table No 1 shows that 36 patients had the habit of smoking, which represents 45% of the total and 17 

consumed alcohol for 21.2%. 

 

Tabla 2.  Distributión according classificatión to the Nyhus. 
(5)

 

Classifica-

tión 

            Right              Left Total 

Frequency % Frequency % 

IIIa 19 33,1 16 34,7 35(35,0%) 

IIIb 21 37,8 20 50,0 41(41,0%) 

IIIc 6 14,1 3 10,8 9 (9,0%) 

IV 8 14,8 7 13,0 15(15,0%) 

Total 54 54,0 46 46,0 100(100%) 

 Thel total is  100 hernias operated on in 80 patients 



CMI 03 (04), 372−377 
CMI JOURNAL 374 

CMI  JOURNAL                                                              Pedro Rolando López Rodríguez et al. 

 

 
 

Table 2 shows that right hernias were more 

frequent in 54.0% of the total; the indirect variety 

with great dilation of the annulus and destruction 

of the posterior wall (IIIb) was the most frequent 

(41 hernias). Nine femoral hernias and 15 

recurrent hernias were operated on. 

The 100 surgeries were performed by PET 

technique (100.0%). Two of the patients in whom 

a PET technique was started had to be converted 

to a conventional prosthetic technique due to 

accidental perforation of the peritoneum, passing 

CO2 into the peritoneal cavity, and consequently, 

the loss of the preperitoneal surgical space, and 

another was the conversion of a failed PET 

technique. 

The mean surgical time for unilateral hernias was 

53.5 min, with a minimum time of 25 min and a 

maximum of 120 min. In bilateral repairs, the 

average surgical time was 71.3 min, with a 

minimum of 40 min and a maximum of 110 

minutes. The hospital stay was less than 24 hours 

in 70 patients (87.5%), in 5 patients it extended 

from 24 to 48 hours and in 5 patients it lasted 

more than 48 hours. 

 

Tabla 3. Complications. 

Complications Intraoperative 

complications 

2  weeks  After   1  month 

Minor bleeding 22  (22%)   

Accidental opening 

of the peritoneum 

9  (9,0%)   

Hematomas  13  ( 13,0% )  

Seromas  4 (4,0% )  

Recurrences   2  (2,0% ) 

 

Table 3 shows minor bleeding as the most frequent complication in the intraoperative period, in 22 repairs 

(22.0%) that originated 13 hematomas (13.0%). No complications were observed after the second week, but 

two patients suffered recurrences (2.0%) more than two months after the operation. 

 

Tabla 4. Evaluatión of the Visual Analog Scale (VAS).
 (6)

 

VAS Inmediate 

preoperative 

First day First week 15  Days First month 

Vas  I 75 (93,7%) 19 (23,7%) 52 (65,0%) 69 (86,3%) 73 (91,3%) 

VAS II 54 (6,3%) 50 (62,5%) 15 (18,7%) 11 (13,7%) - 

VAS III - 7 (8,7%) 5 (6,3%) - - 

VAS IV - 4 (5,1%) 4 (5,0%) - 7 (8,7%) 

VAS V - - 4(5,0%) - - 

N = 80 

 

Table 4 shows the pain classification according to 

the VAS scale. In the immediate postoperative 

period, after the patient recovered from anesthesia, 

75 individuals (93.7%) were classified as VAS I 

and 5 patients as VAS II. At 24 h after the 

operation, 19 patients (23.7%) were classified as 

VAS I, 50 (62.5%) as VAS II, 7 patients as VAS 

III, and 4 as VAS IV. In the first week 

postoperative consultation, 52 patients (65.0%) 

were classified as VAS I and 15 as VAS II, and 

two patients with moderate pain (VAS V) 

appeared in this period. At 15 days after surgery, 

69 patients (86.3%) were VAS I and at one month 

73 (91.3%) were. The incorporation to the usual 

activities, including work, was of 3 patients 

(3.7%) a week after the operation, after 15 days 

there were 23 patients (28.7%) and at month 54 

patients, for 67, 5% of the total.  

Discussion 

Currently, with the improvement of laparoscopic 

techniques, inguinal hernia surgery is emerging as 

safe, feasible and as a good therapeutic option, 

regardless of the age of the patient; However, the 



CMI 03 (04), 372−377 
CMI JOURNAL 375 

CMI  JOURNAL                                                              Pedro Rolando López Rodríguez et al. 

 

 
 

preoperative evaluation of the individual must be 

correct and thorough, specifically the 

cardiorespiratory function, since with the TEP 

method a working space is created between the 

sheets of the transverse lamina, richly 

vascularized, so that the absorption and 

elimination of the CO2 is greater than that 

produced in the peritoneal cavity during 

pneumoperitoneum. (7) 

Although men predominated, there was a slight 

increase in women in the series with respect to 

other authors (8) In laparoscopic practice, the 

finding of hernial defects diagnosed during the 

intraoperative period is frequent, in men and 

women, the latter essentially with a history 

gynecological disorders. 

Although the usefulness of hernia repairs in 

asymptomatic patients is questioned in some 

articles, the authors consider that it would be 

beneficial for the patient, if conditions permit, to 

repair the hernial defect by the TAPP method. (9) 

The relationship between hernial disease and 

physical exertion has been classic since Cooper's 

time. In the series, 68% of the patients performed 

physical activities that involved great and medium 

efforts and also analyzing the multifactorial nature 

in the pathogenesis of hernia disease, it is striking 

that approximately half of the operated patients 

were smokers, a factor that influences in collagen 

metabolism, significantly linked to hernia 

recurrences. (10) 

Most of the repairs were by means of the TEP 

technique and we consider, like other authors, that 

although the TAPP technique brings us closer to 

the area from a perspective familiar to the surgeon 

(peritoneal cavity) and facilitates the so-called 

"learning curve"; Hernia disease -because it is 

considered a parietal defect- should be given a 

solution from this same plane, to avoid the 

probability of serious complications of the intra-

abdominal organs and to leave the transperitoneal 

method as a tactical resource when the totally 

extraperitoneal method is unsuccessful. (eleven) 

Average surgical time was similar to other series. 

(12) It is known that this tends to decrease when 

the surgical team gains in experience. The longest 

operating time recorded was in a patient, who 

started with a PET technique, but due to technical 

difficulties, he was converted to a conventional 

posterior repair. 

The main complications were related to minor 

intraoperative bleeding and postoperative 

hematomas. In 3 patients it was necessary to drain 

the hematoma due to the discomfort caused, 

however, in the rest of the patients with 

hematomas and seromas they were treated with 

conservative measures. In two patients, recurrence 

occurred 2 months after the operation, which was 

interpreted as a technical error. (13, 14) 

Our results coincide with numerous studies that 

affirm less postoperative pain with the use of 

minimal access techniques, as well as a prompt 

socio-occupational reincorporation of patients. (1, 

3, 9, 15) Despite the fact that 70% and 93.3% of 

the patients at 1 week and 15 days after surgery, 

respectively, had no pain or minimal discomfort; 

only 18 individuals (30%) started their usual 

activities before 15 days. These results contrast 

with other studies that report a return to work and 

social activities between 10-15 days 

postoperatively, although it is likely that some 

sociocultural factors are influencing these results. 

(1, 16) 

In the series there were no major intraoperative or 

postoperative complications, only minor bleeding 

and bruising. In most of the patients, before 2 

weeks postoperatively, the pain disappeared, 

however, the return to social work activities after 

15 days was low. 

Conclusions 

Laparoscopic inguinal hernioplasty was an 

effective therapeutic option, especially for patients 

with bilateral and reproduced hernias. It provided 

benefits to patients and families, the former 

joining work and social activities early. 

Conflicts of interest. 

The authors do not declare any conflicts of 

interest.  

Authors' contributions 

Pedro Rolando Lopez R odríguez: he reviewed 

medical records and searched bibliographies. He 

chose thesampling method by selecting the study 

population and analyzing and discussing thetable 

content. 



CMI 03 (04), 372−377 
CMI JOURNAL 376 

CMI  JOURNAL                                                              Pedro Rolando López Rodríguez et al. 

 

 
 

Lais Angelica Ceruto Ortiz: she stated the 

objectives of the study, selected and triangulated 

the variables and performed the translation into 

English and the final revision of themanuscript. 

Olga Caridad León González: she helped in the 

review of medical records and search 

bibliography, performed statistical processing, 

calculated arithmetic mean and standard deviation 

of quantitative variables. 

Jorge Agustin Satorre Rocha: Performed the 

statistical processing, calculated and interpreted 

the chi-square and associated variables according 

to Duncan's test. 

Eduardo Garcia Castillo: Reviewed the literature 

on the subject looking for data epidemiological 

studies worldwide, designed the study 

methodology, classified the research, processed 

the information and narrowed the bibliographic 

references according to Vancouver standards. He 

wrote the document. 

Luis Marrero Quiala: Reviewed the literature on 

the subject looking for data 

epidemiological studies worldwide, designed the 

study methodology, classified the research, 

processed the information and narrowed the 

bibliographic references according to Vancouver 

standards. He wrote the document. 

Referencias Bibliográficas 

1. Ruiz-Funes MAP, Farell RJ, Marmolejo CA, 

Sosa LAJ, Cruz ZA. Abordaje de hernias poco 

frecuentes por cirugía de mínimo acceso: serie 

de casos. Rev Mex Cir Endoscop. 2020; 21 

(1): 6-14. https://dx.doi.org/10.35366/97607. 

2. Magnus H, Anders B, Westerdahl J. 

Laparoscopic extraperitoneal inguinal hernia 

repair versus open mesh repair: long-term 

follow-up of a randomized controlled trial. 

Surgery. 2008; 143(3):313-7. 

3. Bittner R, Bain K, Bansal VK, Berrevoet F, 

Bingener-Casey J, Chen D et al. Update of 

Guidelines for laparoscopic treatment of 

ventral and incisional abdominal wall hernias 

(International Endo hernia Society (IEHS))-

Part A. Surg Endosc. 2019; 33: 3069-3139.  

4. Cruz Alonso JR. La endohernioplastia. 

Detalles técnicos. Arch Cir Gen Dig [serie en 

Internet]. 2007 [citado 10 de diciembre de 

2010]. Disponible en: http://www.cirugest. 

com/revista/2007/17/2007-09-03.htm  

5. Carbonell Tatay F. Hernia inguinocrural. 

Valencia: Ethicon; 2001.p. 141-142. 

6. DeLoach LJ, Higgins MS, Caplan AB, Stiff 

JL. The Visual Analog Scale in the immediate 

postoperative period: intrasubject variability 

and correlation with a numeric scale. Anesth. 

1998; 86:102-6. 

7. Halligan S, Parker SG, Plumb AA, Windsor 

AC. Imaging complex ventral hernias, their 

surgical repair, and their complications. Eur 

radiol. 2018; 28: 3560-3569. 

8. Henriksen NA, Kaufmann R, Simons MP et 

al. EHS and AHS guidelines for treatment of 

primary ventral hernias in rare locations or 

special circumstances. BJS Open. 2020; 4: 

342-353.  

9. León González OC, López Rodríguez PR, 

Danta Fundora LM, Satorre Rocha JA, García 

Castillo E, Ceruto Ortiz LA. Inguinal Hernia 

Repair by  Laparascopy. Surg Cas Stud op 

Acc J. 2019; Vol3 (2): https://lupinepublishers 

.com/surgery_case_studiesjournal/pdf/SCO. 

10. Bórquez MP, Garrido OL, Manterola DC, 

Peña P, Schlageter C, Orellana J, et al. Estudio 

de fibras colágenas y elásticas del tejido 

conjuntivo de pacientes con y sin hernia 

inguinal primaria. Rev Méd Chile. 2003; 

131(11):1273-9. 

11. Díaz Martínez J, Ramírez Colin G. 

Hernioplastia inguinal endoscópico total 

extraperitoneal (TEP). Experiencia de nuestros 

primeros 100 casos en el hospital de segundo 

nivel. Cir Endoscop. 2017 (Acceso): 15 

//2019; 18(2): 125-34. Disponible en: http: 

//www.medigraphic.com/cgibin/new/rewsume

n.cgi.ID articulo=7338. 

12. Martin Gómez M. Cirugía Laparoscópica de la 

hernia inguinal. TEP. Cir Andal. 2018; Vol 29 

(2): 174-77: http: asa cirujanos. com/admin 

/upfiles/revista/2018/cir-Andal_vol29_n2_ 

multi media 8. pdf. 

13. Palmisano EM, Martínez JD, García MM, 

González JD. Maniobras claves y trucos en 

TEP. Rev Hispanoamerican Hernia. 2018; Vol 

6(2): 86-90. http: //dx.doi.org/10.20960/rh.  

14. Hernia Surge Group. International guidelines 

for groin hernia management. Hernia. 2018; 

22: 1-165. 

15. Liu J, Zhu Y, Shen Y, Liu S, Wang M, Zhao 

X et al. The feasibility of laparoscopic 

http://www.cirugest/


CMI 03 (04), 372−377 
CMI JOURNAL 377 

CMI  JOURNAL                                                              Pedro Rolando López Rodríguez et al. 

 

 
 

management of incarcerated obturator hernia. 

Surg Endosc. 2017; 31: 656-660 

16. Morera Pérez M, Roque González R, 

González León T, Sánchez Piñero RO, Olivé 

González JB. Cirugía Abdominal en el adulto 

mayor. Rev Cubana Cir.2019; Vol 58(1): 

(Disponible en) http://scielo.sld.cu. 

 

 

 

  

 

file:///C:/Users/Dell/Downloads/ru/CMI/Vol%204%20Iss%201/(Disponible

