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Purpose: To develop a surgical endoscopy technique for closing the defect of direct inguinal hernia and evaluate the efficacy and safety of a novel suture in the early postoperative period. Methods: A prospective randomized controlled single-center study was conducted at Yudin State Clinical Hospital (Moscow) from February to August 2024. We enrolled 142 male patients over 18 with newly diagnosed direct inguinal hernias and a hernia orifice being 1.5–3 cm, who were treated with extended Totally Extraperitoneal Plasty (eTEP) repair. The patients were randomly assigned to two equal groups: a comparison group that underwent hernia defect closure and a control group that did not receive intracorporeal sutures. Results: On postoperative day 1, ultrasound revealed seromas in 6 patients (11.7%) in the comparison group and in 22 patients (43.1%) in the control group (95% confidence interval [CI] 0.14–0.5, p = 0.05). Mean operation times were 47.25 ± 8.68 for the comparison and 43.63 ± 8.31 min for the control group. Pain intensity on day 2, assessed with a visual analog scale (VAS), was 2.57 ± 1.09 in the comparison group and 2.9 ± 1.29 in the control group, indicating mild to moderate pain. No adverse events occurred in either group 30 days postoperatively. Conclusion: This study presents a novel surgical endoscopy technique for closing direct medial inguinal hernia defects and provides anatomical feasibility. The advantages of the technique include preventing seromas and severe postoperative pain. Further randomized studies are warranted to assess long-term results of this technique and establish clinical indications for its use in surgical practice. [ABSTRACT FROM AUTHOR]