Should occult hernia be repaired in TAPP?

Area of Science:

• Laparoscopic surgery
• Hernia repair
• Surgical outcomes

Background:

• Occult hernias are asymptomatic and found during surgery in up to 22% of laparoscopic inguinal hernia repairs.
• Treatment may prevent future symptoms, but complication risks are unclear, especially with the TAPP approach.

Purpose of the Study:

• To evaluate the safety and outcomes of treating occult hernias during transabdominal preperitoneal (TAPP) repair.
• To compare complication rates between patients who received bilateral repair (including occult hernias) and unilateral repair.

Main Methods:

• Retrospective analysis of 350 patients undergoing elective TAPP repair.
• Division into an occult hernia group (bilateral repair, n=51) and a non-occult hernia group (unilateral repair, n=299).
• Assessment of postoperative complications including seroma, surgical site infection, and acute postoperative inguinal pain (APIP).

Main Results:

• Overall complication rates were similar between groups (13.7% vs. 16.4%, p=0.84).
• Complications on the occult hernia side (seroma and APIP) were significantly lower than on the symptomatic side (2.0% vs. 12.3%, p=0.03).
• Low incidence of seroma and no APIP observed on the occult hernia side.

Conclusions:

• Treatment of occult hernias during TAPP repair has a low complication rate on the occult hernia side.
• The benefit-to-risk balance favors treating occult hernias, with a low number needed to harm (51) versus a favorable number needed to treat (4.6).
• Findings support the safety and rationale for treating occult hernias in TAPP procedures.