Inguinal canal fat encountered during inguinal hernia repair is frequently described as a lipoma, although many lesions are continuous with preperitoneal fat (PPF) rather than true neoplasms. The lack of clear intraoperative criteria has led to controversy regarding routine excision versus conservative management. This study aimed to determine whether intraoperative differentiation between true lipomas and PPF can guide selective surgical management. We retrospectively reviewed 2465 adult patients (aged ≥20 years) who underwent transabdominal preperitoneal (TAPP) repair between January 2019 and December 2023. Among them, 271 patients with fatty tissue in the inguinal canal were analyzed. Intraoperative fatty tissue was classified as either true lipoma or PPF based on encapsulation and continuity with the preperitoneal space. True lipomas were excised, and PPF was managed with reduction alone. The presence of inguinal canal fat was not associated with differences in the demographic or hernia-related clinical characteristics. Recurrence was rare in both groups (0.3% versus 0.4%), with no significant difference between the patients with and without fatty tissue. Operative time was longer in patients with fatty tissue (35.6 ± 8.2 versus 28.9 ± 5.8 minutes, P < .001). Within the fat group, lipoma excision required longer operative time (41.8 ± 9.5 versus 34.9 ± 7.8 minutes, P = .001) and was associated with a higher complication rate (10.0% versus 1.2%, P = .005) than was PPF reduction, while recurrence and metachronous contralateral inguinal hernia were rare in both subgroups. Other postoperative outcomes were comparable between the strategies. Most fatty protrusions encountered in the inguinal canal during TAPP repair were continuous with the PPF layer rather than discrete encapsulated lipomas. In appropriately selected cases, reduction of PPF without excision appeared feasible and safe, with favorable short- and long-term outcomes.

Patients with primary unilateral indirect inguinal hernias and large internal inguinal rings have a higher incidence of seroma formation following laparoscopic transabdominal preperitoneal (TAPP) hernia repair. This study aims to investigate the clinical efficacy of suturing and closing the internal inguinal ring during the TAPP procedure to reduce the postoperative seroma rate. A retrospective analysis was conducted on the clinical data of 162 patients with primary unilateral indirect inguinal hernias and an internal ring defect diameter of ≥ 3.0cm, who were treated at Kunshan First People's Hospital from December 2023 to November 2024. All patients underwent the TAPP procedure with hernia sac transection. Based on whether the internal inguinal ring was sutured closed intraoperatively, patients were divided into two groups: an experimental group (internal ring closure, n = 81) and a control group (no internal ring closure, n = 81).The study compared the incidence of postoperative seromas, perioperative indicators (operative time, incision size, blood loss, length of hospital stay, etc.), and other related complications (postoperative pain, sensory abnormalities, infection, urinary retention, testicular edema, etc.) between the two groups, as well as short-term recurrence rates. There were no statistically significant differences in the baseline characteristics between the two groups, and all surgeries were completed successfully. The incidence of seroma in the experimental group at 7 days and 1 month postoperatively was significantly lower than in the control group [8.64% (7/81) vs. 28.40% (23/81), P = 0.002; and 2.47% (2/81) vs. 13.58% (11/81), P = 0.018, respectively]. Regarding severity (Morales-Conde classification), the experimental group recorded 5 Grade I and 2 Grade II cases, with zero Grade III events; whereas the control group observed 12 Grade I, 8 Grade II, and 3 Grade III events. There were no significant differences in seroma incidence between the two groups at 3 months and 6 months postoperatively (P > 0.05). The operative time for the experimental group [(63.67 ± 9.26) min] was slightly longer than that of the control group [(60.21 ± 10.23) min] (t = 2.255, P = 0.025). There were no statistically significant differences in other perioperative indicators, other related complications, or short-term recurrence rates between the two groups (P > 0.05). For primary unilateral indirect inguinal hernias with an internal ring defect diameter of ≥ 3.0cm, suturing and closing the internal ring defect during the TAPP procedure was associated with a lower rate of seroma formation.

BackgroundCompared with open inguinal hernia repair, laparoscopic approaches, including Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP), improve recovery and reduce pain. However, optimal mesh fixation remains unclear due to limited high-quality comparative evidence. We aimed to evaluate early postoperative pain and quality of life with different mesh fixation modalities (glue, tacks, and sutures) in laparoscopic TAPP inguinal hernia repair.MethodsA single-center, prospective, randomized controlled trial was conducted on 75 eligible adult patients with primary inguinal hernia scheduled for elective TAPP repair. Patients were randomized in a 1:1:1 ratio to glue (n = 25), suture (n = 25), or tack (n = 25) fixation. Primary outcomes were postoperative pain intensity (visual analogue scale, VAS) and hernia-specific quality of life (Carolinas Comfort Scale, CCS) assessed at postoperative day 1 1, 3, and 6 months. Secondary outcomes included operative time, length of hospital stay, time to return to work, complications, recurrence, and procedural cost.ResultsCompared with the glue and suture fixation groups, the tack fixation group had substantially higher pain levels on the first day after the operation and at one month (P < 0.001). Over the 3rd and 6th months, VAS scores were low and comparable across all groups, with no significant differences. The glue group had significantly lower mesh sensation and total CCS scores at all time points compared to the suture and tack groups (P < 0.001).ConclusionsIn the early postoperative period following laparoscopic TAPP inguinal hernia repair, mesh fixation with surgical glue results in superior pain control, better quality of life, and faster return to work compared to sutures and tacks, without increasing early complication rates.Trial registrationClinicalTrials.gov Identifier: NCT07401082 (Registered February 6, 2026; retrospectively registered after completion of enrollment).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12893-026-03801-7.

Mesh erosion into the urinary bladder is an uncommon but potentially serious late complication of laparoscopic inguinal hernia repair, particularly following transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. Proposed mechanisms include inadequate peritoneal coverage, excessive mesh fixation, postoperative infection, and chronic inflammatory responses. Clinical presentation is often delayed and nonspecific, leading to diagnostic challenges and prolonged morbidity. We report the case of a 60-year-old male with recently diagnosed hypertension and diabetes mellitus who had undergone laparoscopic mesh repair for left inguinal hernia (details unavailable). He presented with a 9-month history of recurrent burning micturition, lower abdominal pain, and intermittent hematuria. His history was notable for recurrent urinary tract infections over 5 years. Initial evaluation at another centre revealed vesical calculus, left staghorn calculus, and grade 1 prostatomegaly; he underwent transurethral resection of the prostate with cyst lithotripsy. One month later, his urinary symptoms recurred. Investigations at our center showed, on cystoscopy, polypropylene mesh eroding into the anterior bladder wall. Computed tomography (CT) revealed a heterogeneously enhancing lesion in the right anterolateral bladder wall with contrast extravasation. Definitive surgical management involved laparotomy with excision of the involved bladder wall segment containing the mesh, followed by two-layer bladder repair and suprapubic catheter placement. The patient had an uneventful recovery. Intravesical mesh migration should be considered in any patient with persistent urinary symptoms following laparoscopic inguinal hernia repair. A high index of suspicion, combined with early use of CT urography and cystoscopy, facilitates timely diagnosis. Surgical removal of the mesh with bladder wall repair is curative in most cases. This case underscores the importance of meticulous mesh placement and secure peritoneal closure during laparoscopic hernia repairs to minimize such rare but significant complications.

The efficacy of self-fixating mesh in laparoscopic inguinal hernia repair remains controversial, and its use is not yet explicitly recommended by international guidelines. The short-term outcomes of patients who underwent trans-abdominal pre-peritoneal (TAPP) repair using Parietex™ Lap.ProGrip™ (Lap.ProGrip) during a 10-year period, were retrospectively analyzed, to evaluate its effectiveness at reducing recurrence and chronic post-operative inguinal pain (CPIP). Data from 965 patients (1,129 hernias), aged ≥ 18 years, who underwent TAPP with Lap.ProGrip between November 2014 and October 2024, were retrieved. The standard post-operative follow-up period was 6 months. The primary endpoint was post-operative recurrence, specifically for large direct hernias (Japan Hernia Society [JHS] M3 type). The secondary endpoint was CPIP, which was defined, based on international guidelines, as pain that persisted for ≥ 3 months, required intervention, and interfered with daily activities. The intra-operative videos of all patients with CPIP were reviewed to identify potential procedural causes. The 6-month follow-up completion rate was 88.4%. Although 478 hernias (42.3%) had a defect size ≥ 3cm, including 149 hernias (13.2%) of JHS M3 type, no early recurrences occurred. Four patients (0.5%) had CPIP. Intra-operative video review revealed that in three of the four patients, electrocautery for hemostasis within the "trapezoid of disaster" was performed, suggesting nerve injury, and no mesh-related displacement or folding was observed. The self-fixating mesh provides reliable short-term stability, even for large direct hernias. CPIP appears to be more closely associated with intra-operative hemostatic maneuvers than with the mesh.

Inguinal hernia repair is among the most common surgical procedures worldwide, and the approach is evolving towards minimally invasive techniques such as laparoscopic transabdominal preperitoneal (TAPP) repair. However, open tension-free repairs remain essential in specific clinical contexts. This study aimed to compare perioperative outcomes, postoperative recovery, complication rates, and medical costs between small-incision tension-free mesh repair combined with scrotal drainage and laparoscopic TAPP repair, providing evidence-based guidance for surgical selection in diverse practice environments. A retrospective cohort study was conducted at Yanbian University Hospital between June 2018 and February 2023. A total of 323 consecutive patients were enrolled. Group A included 107 patients who underwent small-incision tension-free mesh repair combined with scrotal drainage, and Group B included 216 patients who underwent TAPP. Baseline demographics were compared to ensure group equivalence. Intraoperative parameters (blood loss, operative time), postoperative recovery indicators (time to first flatus, ambulation initiation, pain resolution), length of hospital stay, medical costs, complication rates, and recurrence within six months were assessed using appropriate statistical tests (p < 0.05 indicated significance). No significant differences in baseline characteristics were detected between the two groups (p > 0.05). Compared with TAPP (Group B), small-incision tension-free mesh repair with scrotal drainage (Group A) was associated with greater intraoperative blood loss (p < 0.001) but a shorter operative time (p < 0.001). Postoperatively, Group A had longer hospital stays and delayed recovery of gastrointestinal function (time to first flatus), ambulation, and pain resolution (all p < 0.001). Total hospitalization costs were significantly lower in Group A than in Group B (p < 0.001). The mean duration of drain placement in Group A was 2.03 ± 0.65 days. Chronic groin pain occurred in 8.4% vs. 4.6% (p > 0.05) of patients, and hernia recurrence rates were 1.9% vs. 1.4% (p > 0.05) for Groups A and B, respectively. Incisional infection was more frequent in Group A (3.7%) than in Group B (0%, p < 0.05). Both small-incision tension-free mesh repair with scrotal drainage and TAPP are safe and effective when performed by experienced surgeons within standardized perioperative protocols. The small-incision approach is particularly suitable for elderly patients and those with comorbidities limiting tolerance to general anaesthesia, as well as for resource-constrained settings. Targeted drain placement effectively prevents postoperative seroma formation but may also increase local tissue trauma, prolong postoperative discomfort, delay mobilization, and increase the risk of superficial wound infection.

Simulation-based training is a critical component of robotic surgical education. While virtual reality platforms are well established for basic skills acquisition, they lack the ability to replicate tissue handling required for procedural simulation. Synthetic models have emerged as a promising alternative; however, formal validation is required prior to their integration into training curricula. This study aimed to establish the face and content validity of the International Medical Robotics Academy (IMRA) Surgical model for robotic transabdominal preperitoneal (TAPP) inguinal hernia repair. A prospective content validity study was conducted using an international expert panel. Surgeons with experience in robotic TAPP repair and prior exposure to the IMRA model were recruited. A 48-item survey instrument was developed and organized across domains including anatomical fidelity, procedural relevance, haptic properties, and educational utility. Items were rated on a 4-point Likert scale. Item-level content validity indices (I-CVI) were calculated, with a threshold of ≥ 0.78 for retention. The scale-level content validity index (S-CVI/Ave) was computed, with ≥ 0.90 considered acceptable. Face validity was assessed using five global rating items (1-10 scale). Ten expert surgeons from three countries participated. The overall face validity score was 8.78/10, with all domains exceeding 8.0, including educational value (9.40) and procedural relevance (8.90). The S-CVI/Ave was 0.929. Of 48 items, 44 (91.7%) achieved I-CVI ≥ 0.78. Four items did not meet the threshold, primarily related to advanced dissection steps and model-specific anatomical features. 90% of experts endorsed the model without reservations. The IMRA synthetic simulation model for robotic TAPP inguinal hernia repair demonstrates strong face and content validity. These findings support its integration into structured robotic training programs and provide a foundation for future studies evaluating construct and criterion validity.

Laparoscopic repair is recommended for inguinal hernia because it is associated with reduced postoperative pain and faster recovery compared with open repair. However, the choice between transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques remains controversial. A prospective randomized, clinical trial was conducted between November 2021 and June 2025. Adult male patients with unilateral uncomplicated inguinal hernias were included. Patients were randomized in a 1:1 ratio to undergo TAPP or TEP repair. The primary endpoint was 30-day postoperative complications graded according to the Clavien-Dindo classification. Secondary endpoints included chronic pain, functional recovery, and recurrence. A total of 144 patients were included and randomized, with 72 patients in each group. Briefly, 30-day postoperative complications were significantly more frequent after TAPP than TEP (19.4% versus 6.9%, P = .024). Most complications were minor (Grades I-II), and three Grade IIIa events required percutaneous aspiration. Chronic pain at 3 months was observed in 5.6% of patients after TAPP and 1.4% after TEP (P = .181). Time to return to normal activity did not differ significantly between groups. After a median follow-up of 26 months, the recurrence rate was 2.8% in both groups. TEP was associated with significantly lower short-term postoperative complications and shorter hospital stays, while long-term outcomes were comparable between techniques.

YouTube has become a widely used tool for surgical education, offering open access to procedural videos for trainees and professionals alike. However, the reliability and pedagogical quality of these publicly available resources remain uncertain. In the context of minimally invasive inguinal hernia repair, we hypothesized that robotic (RT) surgery videos provide superior educational value compared with laparoscopic (LAP) ones. This study aimed to systematically evaluate and compare the quality of RT and LAP transabdominal preperitoneal (TAPP) inguinal hernia repair videos available on YouTube. Based on a priori sample size calculation for moderate effect size (Cohen's d = 0.5), we determined that 63 videos per group would be required for adequate statistical power. On March 19, 2025, a structured search was performed on YouTube using the term "Transabdominal preperitoneal repair for inguinal hernia." This strategy generated an initial pool of 300 potentially eligible videos, which were screened sequentially until the predetermined sample size of 63 videos per group was achieved. Eligible content featured TAPP repairs via RT or LAP approach. Duplicates, non-inguinal TAPP procedures, videos consisting exclusively of animations, conference lectures, or irrelevant videos were excluded. The primary objective was to evaluate videos containing operative demonstrations of surgical procedures. After this selection, two blinded hernia surgeons independently assessed all videos using a newly developed 21-item qualitative evaluation tool and the validated LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) score, a tool for evaluating surgery videos submitted to presentations and publications. Group comparisons were conducted using Welch's t-test and Mann-Whitney U test. Effect size was reported using Cohen's d. Both assessment tools demonstrated adequate inter-rater agreement and internal consistency, supporting their reliability for evaluating educational video content. From 300 videos screened, 126 met inclusion criteria (63 RT, 63 LAP). RT videos scored significantly higher than LAP videos on the newly developed qualitative evaluation tool (mean score 0.54 vs. 0.44; P < .001; Cohen's d = -0.60), indicating a moderate effect size. Similarly, RT videos demonstrated higher LAP-VEGaS scores (7.46 vs. 6.34), although this difference did not reach statistical significance (P = .091). These findings suggest that RT videos present superior adherence to technical and educational standards, respectively. Both assessment tools demonstrated adequate inter-rater agreement and internal consistency, supporting their reliability for evaluating educational video content. YouTube contains a large repository of TAPP repair videos, but quality is inconsistent. The new qualitative tool demonstrated strong reliability and internal consistency, supporting its use for educational video assessment. RT videos showed greater adherence to technical and educational standards compared with LAP. RT videos may therefore offer more structured learning content, but general quality improvements remain necessary across both approaches.

Robotic ventral hernia repair (VHR) has enabled minimally invasive management of complex abdominal wall hernias. As robotic procedures involve distinct technical demands and require progressive skill acquisition, understanding learning curves (LCs) is essential to define proficiency thresholds, optimize surgical training, and ensure safe implementation of these techniques. This systematic review compared LCs in robotic VHR across surgical techniques. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of major medical databases (PubMed/MEDLINE, EMBASE, Web of Science, Lilacs, and the Cochrane Library) was performed through August 2025, including cohort studies on adult patients undergoing elective robotic VHR. Seven retrospective cohort studies were included, comprising six single-surgeon series: one robotic intraperitoneal underlay mesh (rIPUM), one robotic transversus abdominis release (rTAR), one robotic transabdominal preperitoneal (rTAPP), three robotic enhanced-view totally extraperitoneal (r-eTEP), and one population-based analysis including 12,609 cases. The single-surgeon series predominantly involved patients with class I obesity (mean body mass index range: 31.0-33.0 kg/m2). LC assessment was heterogeneous, employing cumulative sum (CUSUM), risk-adjusted CUSUM (RA-CUSUM), chronological case grouping, and multivariable regression modeling. Across single-surgeon studies, operative efficiency improved earlier than complication-adjusted or technical quality outcomes. Operative-time (OT) proficiency thresholds were reported at 26 cases for rIPUM, 29-38 for r-eTEP, 46 for rTAPP, and 49 cases for rTAR. However, stabilization of complication-adjusted performance required higher volumes, ranging from 51 to 64 cases. Prior experience substantially shortened the LC, reducing OT proficiency for r-eTEP to just 8 cases. In contrast, population-level analysis suggested that 16-19 robotic cases were required to achieve recurrence-related reoperation rates comparable to open or laparoscopic repair. LCs in robotic VHR follow a two-phase, technique-dependent pattern. While operative efficiency is achieved earlier, optimal patient outcomes require higher case volumes.

Laparoscopic transabdominal preperitoneal (TAPP) versus open Lichtenstein primary unilateral inguinal hernia repair: A systematic review and meta-analysis of randomized controlled trials.

The transabdominal preperitoneal (TAPP) approach is a widely used minimally invasive technique for laparoscopic inguinal hernia repair. However, operative time and technical difficulty may vary depending on patient-related anatomical factors. This study evaluated the effect of the umbilicus-symphysis pubis (USP) distance on operative time and investigated whether this superficial anatomical measurement could guide patient selection. Methods In this retrospective study, data from 767 patients who underwent TAPP repair at Gazi University Hospital between January 2015 and June 2022 were reviewed. After applying the exclusion criteria, 341 male patients were included. Of these, 272 had unilateral and 69 had bilateral inguinal hernia. The distance between the umbilicus and symphysis pubis was measured preoperatively in all patients. The relationship between USP distance and operative time was analyzed using the Python-based Maximally Selected Rank Statistics (MaxStat) method, and optimal cut-off values were determined. The age range of the study group was 18.00-77.00 years, with a median age of 44.00 years. The USP distance ranged from 9.70 to 23.50 cm in unilateral cases and from 11.10 to 22.30 cm in bilateral cases. MaxStat analysis identified optimal cut-off values of 15 cm for unilateral and 16 cm for bilateral hernia cases. In unilateral cases, operative time was significantly longer in patients with a USP distance ≤ 15 cm (p < 0.001). Similarly, in bilateral cases, operative times were significantly longer when the USP distance was ≤ 16 cm (p < 0.001). Conclusion USP distance may serve as a simple and easily measurable anatomical parameter associated with surgical duration, particularly in unilateral TAPP repairs. As patients with a shorter USP distance were associated with longer operative times, this association warrants further prospective validation before USP distance can be considered a routine parameter in preoperative planning.

The extended-view totally extraperitoneal (eTEP) technique is designed to overcome the limited working space and fixed port constraints of conventional totally extraperitoneal (TEP) hernia repair. This study aimed to provide a direct, randomised comparison of early outcomes between the eTEP approach and the transabdominal pre-peritoneal (TAPP) technique for groin hernias. A prospective, randomised, single-blind, parallel-group trial was conducted at a tertiary care centre. Seventy patients were allocated to either eTEP or TAPP repair (35 per group). Early post-operative complications - defined as post-operative pain, seroma and scrotal hematoma - were assessed as the primary composite endpoint. Key secondary endpoints included operative time, intraoperative complications, blood loss, hospital stay and early recurrence. Demographic and hernia characteristics were comparable at baseline. While Visual Analogue Scale pain scores decreased significantly over time in both groups ( P < 0.001), there was no statistically significant difference between the groups at any assessed interval. Seroma was clinically detected in three patients (8.6%) in the eTEP group at 1 week, all of which resolved spontaneously; no seromas occurred in the TAPP group ( P = 0.239). The median operative time was significantly shorter for eTEP (85 min, interquartile range [IQR]: 76-103) compared to TAPP (94 min, IQR: 87-110; P = 0.011). Rates of intraoperative complications, blood loss and mean hospital stay were similar between groups. Both eTEP and TAPP are safe and effective for groin hernia repair, demonstrating comparable early post-operative pain and morbidity. The eTEP technique was associated with a statistically significant reduction in operative time, positioning it as a valuable surgical alternative to TAPP. Clinical Trials Registry-India (CTRI/2023/09/057520).

The impact of hernia sac volume on post-operative pain and operative time in laparoscopic transabdominal pre-peritoneal (TAPP) and enhanced-view totally extraperitoneal (eTEP) repair of unilateral inguinal hernia remains unexplored. This study aimed to evaluate differences in post-operative pain between TAPP and eTEP techniques based on hernia sac volume quantified by computed tomography (CT), with operative time as a secondary outcome. This prospective randomised study was conducted at a single centre in Pune, Maharashtra, India, from September 2022 to August 2023. Seventy-two male patients with unilateral inguinal hernia were randomised equally into TAPP (n = 36) and eTEP (n = 36) groups. Hernia sac volume was calculated preoperatively using an ellipsoidal formula applied to diameters derived from Computed Tomography scan and expressed as a volume ratio (volume of hernia sac to volume of abdominal cavity). Post-operative pain was assessed using the Visual Analogue Scale (VAS) at 24 hrs and 36 hrs. Operative time was recorded for all procedures. Statistical analysis employed the Mann-Whitney U-test for pain scores and independent samples t-test for operative time. At 24 hrs, the mean VAS score was significantly lower in the eTEP group (3.06 ± 1.09) than in the TAPP group (3.97 ± 1.18; P = 0.0011). Both groups exhibited a non-linear pain response relative to sac volume, with higher pain in smaller sacs, a decrease in mid-sized sacs and a drop in larger sacs. At 36 hrs, VAS scores converged between TAPP (2.51 ± 0.74) and eTEP (2.45 ± 0.71; P = 0.73). The mean operative time was significantly shorter for eTEP (41.61 ± 5.43 min) compared to TAPP (54.83 ± 5.93 min; P = 7.19 × 10-15). The eTEP technique demonstrated significantly lower post-operative pain at 24 hrs and shorter operative time compared to TAPP for unilateral inguinal hernia repair. Hernia sac volume influenced pain patterns in both groups, with smaller sacs associated with higher pain scores. These findings support the consideration of hernia sac volume as a clinical parameter for planning surgical technique.

Background/Objectives: This study aimed to determine the inguinal hernia recurrence rate after transabdominal preperitoneal (TAPP) repair, particularly considering the effect of simultaneous umbilical hernia repair. The secondary aim was to assess whether closing the 10 mm midline supraumbilical port-site fascia affects the incidence of trocar-site hernia (TSH) following inguinal TAPP. Methods: We reviewed medical records of consecutive patients undergoing inguinal TAPP at the Department of Surgery, University Hospital Centre Zagreb, between 1 January 2014 and 30 June 2022, and supplemented the data with telephone follow-up. Demographic, clinical, and operative variables were compared between patients who did and did not report inguinal hernia recurrence. Patients were also grouped by operating surgeon to compare TSH rates. Surgeon A routinely closed the 10 mm supraumbilical fascial defect with a single suture, while Surgeon B mostly did not, deciding on a case-by-case basis. Results: The analysis included 281 patients with a median follow-up of 60 months. The overall recurrence rate was 10.6%. Baseline demographic and clinical characteristics did not differ significantly between patients who reported recurrence and those who did not. A prior hernia repair was more common in the recurrence group (34.1% vs. 17.2%; p = 0.007). Concomitant umbilical hernia repair was performed in 12.5% of cases. Patient-reported recurrence was higher after combined TAPP and umbilical hernioplasty than after TAPP alone (14.3% vs. 12.2%), but this difference was not statistically significant (p = 0.784). Surgeon A had a lower observed TSH rate than Surgeon B (1.0% vs. 3.6%), although this difference did not reach statistical significance (p = 0.242). Conclusions: Concurrent TAPP and umbilical hernioplasty is not associated with a higher recurrence rate, but further research on a larger cohort is necessary. Routine closure of the 10 mm midline supraumbilical fascial defect could reduce the TSH rate, although the difference was not statistically significant. The side of the hernia does not influence recurrence after TAPP.

To evaluate the differences in quality of life at 5 years postoperatively between laparoscopic transabdominal preperitoneal repair (TAPP) and Lichtenstein tension-free repair for adult patients with primary unilateral inguinal hernia, with a primary focus on EuraHS-QoL scale scores and an exploration of long-term outcomes including chronic postoperative pain, recurrence rates, functional recovery, and patient satisfaction. This was a single-center retrospective cohort analysis. Adult patients who underwent TAPP or Lichtenstein repair for primary unilateral inguinal hernia between January 2015 and December 2020 were included. Patients were categorized into a TAPP group (n = 300) and a Lichtenstein group (n = 200) based on the surgical approach. The primary outcome was the quality of life score at 5 years postoperatively, assessed using the EuraHS-QoL scale across three domains: pain, activity restriction, and cosmetic appearance. Secondary outcomes included the incidence of chronic postoperative pain, hernia recurrence rate, postoperative complications, time to functional recovery (e.g., return to daily activities and work), and subjective satisfaction. Multivariate regression models were used to control for confounding factors, and sensitivity analysis was performed using propensity score matching (PSM). The median follow-up duration was 62 months (IQR: 60-66). The TAPP group demonstrated a significantly better total EuraHS-QoL score [median 2.0 (IQR: 1.0-4.0)] compared to the Lichtenstein group [median 3.0 (IQR: 2.0-5.0)] (P < 0.001), with particularly pronounced differences in the activity restriction and cosmetic appearance domains (P < 0.01). The TAPP group had a lower incidence of chronic postoperative pain (12.0% vs. 20.5%, P = 0.006), faster functional recovery (time to return to daily activities: 6 days vs. 8 days, P < 0.001), and higher satisfaction scores (8.8 ± 1.1 vs. 7.9 ± 1.4, P < 0.001). No statistically significant differences were observed between the two groups in recurrence rates or overall complication rates. The findings remained consistent after multivariate regression and PSM analysis. In this retrospective analysis, both TAPP and Lichtenstein repair provided favorable long-term quality of life. While initial unadjusted comparisons suggested a total score advantage for TAPP, this was not maintained in the matched sensitivity analysis. TAPP demonstrated benefits in reduced chronic pain and faster functional recovery, without increasing recurrence. These findings support the consideration of TAPP as a viable option in suitable patients, though they should be interpreted in light of the study's retrospective design and require prospective validation.

Laparoscopic repair has become the preferred approach for inguinal hernia due to its lower post-operative morbidity and faster recovery. However, the choice of mesh fixation remains a topic of debate. Self-adhesive meshes were developed to eliminate the need for mechanical fixation, aiming to reduce post-operative pain, though their long-term outcomes compared to traditional tacker fixation are still under investigation. This study aimed to compare recurrence rates and post-operative outcomes between self-adhesive and tacker-fixed polypropylene meshes in transabdominal preperitoneal (TAPP) inguinal hernia repair. An observational cohort study including 400 patients who underwent TAPP laparoscopic repair between 2018 and 2023 in hospitals across Rio de Janeiro, Brazil. Demographic variables, hernia laterality, mesh type, complications and recurrence were recorded. Fisher's exact test and linear regression were used. P ≤ 0.05 was considered significant. Follow-up was 3 months. The sample consisted predominantly of males (89.5%), with bilateral hernias being the most common presentation (51.25%). Self-adhesive mesh was used in 72.5% of cases, and polypropylene mesh with tacker fixation in 27.5%. The overall recurrence rate was 6%, with no significant difference between mesh types (P = 0.249). The global complication rate was 4.25%, mainly post-operative pain (3.0%) and seroma (0.75%), with no significant differences between groups. Self-adhesive and tacker-fixed polypropylene meshes demonstrated comparable recurrence and complication rates in TAPP repair. Self-adhesive meshes remain a safe alternative that eliminates the need for mechanical fixation, although longer follow-up studies are required to assess late recurrence and long-term outcomes.

BACKGROUND Ventral hernias are more frequent in obese patients. Open ventral hernia repair carries considerable morbidity in the form of seroma formation and surgical site infection. Laparoscopic IPOM (Intraperitoneal only mesh) repair is associated with severe postoperative pain and adhesion obstruction. Ventral TAPP (transabdominal pre-peritoneal) repair has reduced postoperative pain and adhesion formation but has a long learning curve. The aim of our study was to compare the feasibility and efficacy of ventral TAPP repair with IPOM plus repair in the treatment of ventral hernia in obese patients. MATERIALS AND METHOD This prospective and comparative study was carried out in surgical department of Bahawal Victoria Hospital Bahawalpur. Group A included 22 patients in whom laparoscopic ventral TAPP repair was performed, and group B also included 22 patients in whom laparoscopic IPOM plus repair was performed. Data was collected on a pro forma and analysed using SPSS Statistics version 27. RESULTS Mean operating time was significantly longer in group A than in group B (p value &lt; .001). Postoperative pain (VAS score) at days 1, 2, and 15 was more severe in group B than in group A. The complication rate was higher in group B than in group A. (13.65% vs. 4.55%). Mean hospital stay was shorter in group A than in group B (2.545 ± 1.01 vs. 3.73 ± 1.08). CONCLUSION Regarding the feasibility of ventral TAPP in obese patients, it is technically demanding and has a long learning curve. In efficacy as compared to IPOM plus in terms of postoperative pain, complications, recurrence, hospital stay, and cost-effectiveness, ventral TAPP is better than IPOM plus. KEY WORDS: Ventral Hernia, Obesity, Laparoscopic IPOM plus, Laparoscopic Ventral TAPP

Vesicocutaneous fistula (VCF) represents an extremely rare complication following laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair, with fewer than twenty cases documented worldwide. We report a 46-year-old diabetic male who developed VCF 12 months after laparoscopic TAPP repair for left inguinal pantaloon hernia. The patient presented with malodorous watery discharge during micturition from a cutaneous opening in the left inguinal region. Magnetic resonance imaging demonstrated a fistulous tract connecting the anterior bladder wall to the overlying skin. Cystoscopy confirmed mesh erosion into the bladder with an internal opening on the anterior wall. Surgical management included complete fistulectomy, mesh removal and two-layer bladder repair reinforced with omental patch. Complete fistula healing was achieved at 3 months with no recurrence of either the fistula or hernia. This case demonstrates that VCF can occur despite technically adequate TAPP repair and emphasises the need for high clinical suspicion when patients present with delayed inguinal symptoms, particularly in diabetic patients.

Independent postmarket clinical evidence for newly introduced inguinal meshes remains limited. We conducted amulticenter prospective observational study to assess early safety and effectiveness of fixation-free SWING-Mesh in transabdominal preperitoneal (TAPP)/totally extraperitoneal (TEP) repair. We aimed to assess early (3-month) safety and effectiveness of fixation-free SWING-Mesh use in TAPP/TEP repair. Aprospective cohort study was conducted in 20 Polish centers, of which 1 was excluded after central monitoring. Consecutive adults underwent elective TAPP or TEP repair with theunfixed polypropylene SWING-Mesh. Exclusion criteria comprised emergency surgery, bowel resection, contraindications to laparoendoscopic repair, and large direct M3 hernias. Recurrence, complications, unplanned visits/interventions and pain (as per theVisual Analog Scale [VAS]) atdischarge, 7-10 days, 30 days, and 3 months postoperatively were recorded. Theunit of analysis was theoperated groin (case). We analyzed 294 cases in atotal of 283 patients ata mean (SD) age of 51.9 (15.9) years, 84.4% of which were men. TAPP repair was performed in 86.4%, and TEP procedure in 13.6% of thepatients. There were no instances of hernia recurrence by 3 months postsurgery. Pain decreased over time (P<⁠0.001): mean (SD) VAS score of 1.8 (1.4) atdischarge, 1 (1.2) at7-10 days, 0.5 (1.1) at30 days, and 0.5 (1) at3 months postoperatively. At3 months after theprocedure, 78.5% of theindividuals reported aVAS score of 0, and 3.1%, ascore equal to or greater than4. Complication rates were below 10% ateach time point and were mostly minor; 6.9% or fewer patients required anunplanned visit or intervention by 3 months postoperatively. Fixation-free SWING-Mesh use in TAPP/TEP repair was associated with favorable early outcomes. Twelve-month follow-up will report long-term recurrence and chronic pain.