Modified TAPP is the standard procedure for complex inguinal and femoral hernias: late results and patient satisfaction

Abstract

Can the routine use of a modified endoscopic laparoscopic hernioplasty (TAPP) in the treatment of complex inguinal and femoral hernias achieve similar low complication rates and patient satisfaction as with primary hernias? 93.9% of all 7010 inguinal and femoral hernias operated from 1993 to 2009 were treated with a modified TAPP. 4 subgroups of patients with 1492 hernias, operated 1994, 1999, 2004 and 2009 and with structural equality to all hernias, were enrolled in a retrospective follow-up study of 17 years, including femoral hernias, scrotal hernias, hernias after radical open prostatectomy, incarcerated hernias, hernia recurrences after anterior repair and recurrences after failed TAPP/TEP (Laparoscopic transabdominal preperitoneal hernia repair/Endoscopic totally extraperitoneal inguinal hernia repair) procedure. Intra- and postoperative complications were analyzed and 856 living patients with 1123 hernias were asked with a comprehensive questionnaire for late complications and satisfaction with their operation. The follow-up was 94%. 99.1% of all patients had no early and 97.2% no late postoperative complications. Hernia recurrences (1.5%), hydrocele formation (0.3%) and trocar hernias (0.3%) were the most common complications without significant differences between complex and primary hernias. Postoperative pain longer than 3 weeks was reported by 7.8% of the patients. Only 2 patients with femoral hernias and 2 patients with incarcerated phernias were not satisfied with the result of TAPP hernioplasty because of chronic pain or trocar hernia. Experienced endoscopic laparoscopic hernia surgeons have the same or lower complication rates in TAPP therapy in complex inguinal and femoral hernias as in primary hernias with a high patient satifaction with the outcome of TAPP hernioplasty.