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Minimally invasive approach for inguinoscrotal hernia repair. A systematic literature review
Andrea Balla1,2, Alberto Sartori3, Monica Ortenzi4
1Department of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Sevilla, Spain.
Background:
This systematic review reports the presently available evidence regarding the results of the minimally invasive surgery (MIS) approach for the treatment of inguinoscrotal hernias (ISHs).
Methods:
After PROSPERO registration (CRD-42023493129), a search was performed in the MEDLINE, Embase, and Web of Science databases.
Results:
One-thousand-fifty-two patients were included (78.3% and 21.7% underwent transabdominal preperitoneal repair [TAPP] and totally extraperitoneal repair [TEP], respectively). Twenty-one complications occurred during TAPP (2.5%), and 28 occurred during TEP (12.3%). Conversion to open surgery for TAPP procedure was reported in seven patients (0.8%). TEP procedure required conversion to TAPP in 19 patients (8.3%), and open surgery in 18 patients (7.9%) (overall conversion rate 16.2%). Postoperative complication rate was 30.1% (317 patients), with 193 after TAPP repair (23.4%) and 124 after TEP repair (54.4%) (including Clavien-Dindo I-IV). Length of hospital stay ranged between one to five days after both repairs. The overall recurrence rate was 1.6% (19 recurrences), of which 12 (1.3%) and seven (2.8%) recurrences after TAPP and TEP, respectively.
Conclusions:
MIS approaches for ISH repair are technically challenging. TEP repair should be avoided in case of ISH repair, due to the high rate of postoperative complications, risk of conversion and recurrences.
Insights
Minimally invasive surgery for inguinoscrotal hernias (ISHs) presents challenges. Totally extraperitoneal (TEP) repair is not recommended due to higher complication and recurrence rates compared to transabdominal preperitoneal (TAPP) repair.
Area of Science:
- Surgical Innovation
- Gastroenterology
- Hernia Repair
Background:
- Minimally invasive surgery (MIS) is increasingly explored for inguinoscrotal hernias (ISHs).
- Evidence on the outcomes of MIS for ISH repair is still evolving.
Purpose of the Study:
- To systematically review current evidence on MIS for ISH treatment.
- To compare the outcomes of different MIS techniques for ISH repair.
Main Methods:
- Systematic review of MEDLINE, Embase, and Web of Science databases.
- PROSPERO registration (CRD42023493129).
- Inclusion of 1052 patients undergoing transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) repair.
Main Results:
- TAPP was performed in 78.3% of patients, TEP in 21.7%.
- Complication rates were 2.5% for TAPP and 12.3% for TEP intraoperatively.
- Postoperative complication rates were 23.4% for TAPP and 54.4% for TEP. Overall recurrence rate was 1.6% (1.3% TAPP, 2.8% TEP).
Conclusions:
- MIS for ISH repair is technically demanding.
- TEP repair is associated with higher postoperative complications, conversion rates, and recurrences, suggesting it should be avoided for ISH.
- TAPP appears to be a safer MIS option for ISH repair.
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