Efficacy of the caudal view technique in mesh placement during laparoscopic inguinal hernia repair, with propensity...

To prevent recurrence after inguinal hernia surgery, placing a large mesh that ensures adequate overlap of the hernial orifice is crucial. However, using totally extraperitoneal (TEP) approach, the arcuate line can obstruct the creation of sufficient space for large meshes, making the application challenging. To solve this problem, we introduced a caudal view technique (CVT), inserting a 5-mm scope from a cordal port, to assist in making sufficient space for mesh placement, and dissecting the arcuate line as needed. This study aimed to evaluate the effectiveness of the CVT method in facilitating appropriate large mesh placement.

In this retrospective study, data of 58 patients diagnosed with inguinal hernia and treated with TEP between April 2020 and March 2024 were analyzed. The patients were divided into the conventional three-port TEP and CVT groups. We compared the rate of proper 15.7 × 10.3-cm mesh placement, mesh placement time, and operative time between the two groups. Secondary outcomes included the recurrence rate, incidence of intraoperative, and postoperative complications. Propensity score matching was performed to adjust for potential confounders.

The rate of proper mesh placement was 48.4% and 92.6% in the conventional and CVT groups. The average mesh attachment time was shorter in the CVT group. The average operative time was similar between the two groups. Recurrence occurred in one patient in the conventional group, whereas no recurrence was found in the CVT group. No significant differences were observed regarding intraoperative and postoperative complications.

The CVT method could allow for sufficient dissection of the myopectineal orifice and facilitate large mesh placement within shorter time.