ReTAPP for recurrent inguinal hernia after laparoscopic repair: extended experience and comparative analysis

Current international guidelines recommend an open anterior approach for inguinal hernia recurrence after a previous laparo-endoscopic repair. However, repeated laparoscopic repair (reTAPP) has emerged as a potential alternative in highly specialized centers. We aimed to compare the safety, feasibility, and outcomes of reTAPP versus open anterior repair in patients with recurrence after previous laparoscopic inguinal hernia repair.

Retrospective analysis of all transabdominal preperitoneal (TAPP) repairs performed between January 2010 and December 2023. Patients with recurrence were divided into Group 1 (reTAPP) and Group 2 (open anterior repair, Lichtenstein). Demographics, operative variables, postoperative outcomes, morbidity, and re-recurrence were assessed.

Among 3,728 TAPP repairs, 76 recurrences (2.03%) were identified. Fifty-one patients (67.1%) underwent reTAPP and twenty-five (32.9%) open repair. Operative time was 87.5 min in Group 1 vs. 91.2 min in Group 2 (p = 0.59). Hospital stay was shorter with reTAPP (0.6 vs. 1.2 days; p < 0.05). Postoperative pain scores were significantly lower in Group 1 at discharge and at 1 week (p < 0.05). Overall morbidity was low (9.8% vs. 12%), with minor wound complications in both groups, all managed conservatively. Conversion rate in Group 1 was 7.8% due to adhesions. Re-recurrence rates were comparable (3.9% vs. 4.0%).

In high-volume centers, reTAPP is a safe and effective option for recurrent inguinal hernia after prior laparoscopic repair, associated with shorter hospital stay and less postoperative pain, with comparable re-recurrence rates.