Waste production following Shouldice and transabdominal preperitoneal inguinal hernia repair

Surgical procedures generate significant amounts of waste, which contribute to environmental pollution and carbon emissions. Although previous studies have analysed waste from various surgeries, no data exist on hernia repair procedures. This study aimed to quantify and compare the surgical waste produced during Shouldice and laparoscopic transabdominal preperitoneal (TAPP) procedures for unilateral primary inguinal hernia repair.

Between August 2024 and February 2025, waste from 20 Shouldice repairs at Shouldice Hospital (Canada) and 20 TAPP procedures at University Hospital Brandenburg (Germany) were measured. Waste was categorised into eight groups: plain paper/cardboard, laminated paper, soft plastics, hard plastics, latex material, metal foil, fabrics and metal. Carbon dioxide (CO₂) emissions were estimated using emission factors provided by the Intergovernmental Panel on Climate Change.

Fabrics constituted the largest waste component, with an average of 737.1 ± 548.2g per procedure. TAPP procedures generated significantly more waste in plain paper/cardboard, soft plastics, hard plastics and fabrics than Shouldice repairs. The most notable difference was in fabric waste, which was approximately sixfold higher in TAPP (1,263.6 ± 169.5g) compared with Shouldice (210.7 ± 68.6g). Conversely, Shouldice repairs resulted in significantly higher waste from latex and metal.

This study demonstrates substantial differences in surgical waste production between Shouldice and TAPP procedures. The findings emphasise the environmental impact of different surgical techniques, highlighting the need for waste-reduction strategies in hernia repair. Further research should focus on sustainable practices to minimise the carbon footprint of surgical procedures.