Technical tips following more than 2000 transabdominal preperitoneal (TAPP) repair of the groin hernia

Laparoscopic approach is increasingly adopted as a preferred method to treat inguinal hernia. Transabdominal preperitoneal and total extraperitoneal repairs are the 2 techniques currently used.

Between September 1999 and July 2009, more than 2000 patients underwent transabdominal preperitoneal repair of groin hernia at our minimal access unit. A standard technique is used in the majority of patients. Modifications are applied when necessary depending on the complexity of the case. All patients are considered for laparoscopic repair unless they have large irreducible inguino-scrotal hernia or are considered high risk for pneumoperitoneum because of their cardiorespiratory problems. Day surgery, 23-hour service, and inpatient admission are adopted depending on the age, body mass index, comorbidities, and social support. Outpatient postoperative follow-up is normally arranged for 1 visit.

A total of 2196 patients underwent transabdominal preperitoneal groin hernia repair. Morbidity included 63 (2.86%) seromas. Hematoma is reported in 6 (0.27%), 2 (0.09%) patients needed blood transfusion whereas 1 patient needed reexploration. Pain and parasthesia at 6 months are reported in 6 (0.27%) and 2 (0.09%) patients, respectively. Port-site hernia is confirmed in 5 (0.22%) patients, whereas in 2 (0.09%) mesh infections are reported. Both were treated successfully using intravenous antibiotics. Four (0.1%) hydroceles are confirmed and 1 (0.04%) bowel obstruction through a defect in the peritoneal flap. Recurrence of hernia is confirmed in 4 (0.18%) patients.

A standardized technique of laparoscopic hernia repair is associated with minimum morbidity. Modification of the technique is necessary in some patients depending on the complexity of the case.