Mastering Transabdominal Preperitoneal (TAPP): A 5,124 Case Journey in Hernia Repair With a Singular Approach and Our...

Background Inguinal hernia is a common surgical condition resulting from a defect in the myofascial plane, with both congenital and acquired etiologies. Although open repair has traditionally been the standard approach, over the last decade, laparoscopic repair, particularly the transabdominal preperitoneal (TAPP) method, has gained popularity due to its diagnostic and therapeutic advantages. However, its adoption has been limited due to technical complexity and perceived complication risks. Objective To present our technique, perioperative strategy, and outcomes in a large cohort of patients undergoing laparoscopic TAPP hernia repair, with a focus on refining surgical steps to optimize safety and efficacy. Methods A retrospective review was conducted on laparoscopic TAPP hernia repairs performed on 5,124 patients over a defined period. Institutional ethical approval was obtained. Preoperative assessments included dynamic imaging and individual risk stratification. Surgical technique emphasized wide preperitoneal dissection, tailored mesh placement with at least 3 cm overlap, and meticulous closure of peritoneal flaps. A four-port approach was used, and a variety of groin hernias (inguinal, femoral, and obturator) were included. Concurrent umbilical and Spigelian hernias were repaired when encountered. Results Of the 5,124 patients, 4,252 were males (83%), and 872 were females (17%). The technique proved feasible across a broad body mass index (BMI) spectrum (19-46) and in patients with prior abdominal surgery. Complications were minimal, conversion to open surgery occurred in 13 patients (0.25%) of cases, and recurrence rates were low (less than 0.3%). 153 patients (3%) developed seroma/hematoma formation, whereas 256 patients (5%) developed urinary retention postoperatively. The tailored use of overlapping mesh segments and cautious dissection minimized the risk of recurrence and postoperative complications such as seroma or chronic pain. Conclusion Our experience with laparoscopic TAPP repair suggests that, when performed by an experienced surgeon using a standardized technique and with careful attention to anatomical detail, this approach can be safe and effective. When utilised by an experienced surgeon, TAPP enables comprehensive groin assessment, supports early recovery, and can deliver durable repair outcomes, including in more complex cases. With appropriate training, these findings support the continued and considered adoption of the TAPP approach in hernia surgery.