Standard TAPP with flat mesh versus TAPP with flat mesh plus mesh plug for inguinal hernia repair: a preliminary...

Inguinal hernia repair is a common surgical procedure. While laparoscopic transabdominal preperitoneal (TAPP) repair is widely adopted, the comparative efficacy of standard flat mesh alone versus flat mesh plus mesh plug augmentation remains an area of ongoing clinical evaluation. This study aimed to compare these two techniques with respect to recurrence, postoperative pain, and patient recovery.

In this preliminary, single-center randomized trial, 63 patients undergoing TAPP repair for inguinal hernia were randomly assigned to either a standard TAPP with flat mesh alone group (n = 33) or a TAPP with flat mesh plus mesh plug augmentation group (n = 30). A single surgeon performed all procedures. Demographics, operative details, time to return to work, postoperative pain (measured via a Visual Analog Scale [VAS]), patient satisfaction, and hernia recurrence were documented during hospitalization and at follow-up intervals over 12 months. Statistical analysis was performed using SPSS v26, employing t-tests, Mann-Whitney U tests, and Chi-square tests where appropriate.

The cohorts were comparable regarding age, Body mass index (BMI), and baseline clinical characteristics. The recurrence rate was significantly higher in the standard TAPP with flat mesh alone group, reaching 12.1% at 3 months and 21.2% at 6 and 12 months, whereas no recurrences (0%) occurred in the mesh plug-augmented group (p < 0.05). Although early postoperative pain scores were similar between the groups, chronic pain outcomes significantly favored the mesh plug-augmented cohort; 0% reported chronic pain at 12 months compared to 21.2% in the standard TAPP group (p < 0.05). Consequently, overall patient satisfaction was significantly higher in the mesh plug-augmented group (96.7% "very satisfied") than in the standard TAPP group (81.8% "very satisfied"). The standard TAPP group demonstrated a trend toward a shorter time to return to work (93.9% resuming within 1-3 days), but this difference did not reach statistical significance (p > 0.05).

TAPP repair with flat mesh plus mesh plug augmentation was associated with significantly lower recurrence rates (0% vs. 21.2%) and lower chronic pain rates (0% vs. 21.2%) compared to standard TAPP with flat mesh alone. However, given the small sample size, lack of an a priori sample size calculation, and single-center design, these findings should be interpreted strictly as hypothesis-generating. Larger, adequately powered multicenter trials are required to confirm whether routine mesh plug augmentation confers a definitive clinical advantage.