Publication Details
Abstract
Background: Laparoscopic transabdominal preperitoneal (TAPP) repair is widely accepted for inguinal hernia treatment due to reduced postoperative pain, faster recovery, and superior visualization of bilateral defects. Nevertheless, postoperative complications—including seroma formation, chronic inguinal pain, and recurrence—remain clinically significant. Standardization of surgical technique and perioperative pathways may improve outcomes. Objective: To evaluate the impact of a structured optimization protocol for TAPP hernioplasty on postoperative morbidity, recurrence-free survival, and length of hospital stay. Methods: A single-center retrospective–prospective cohort study included 228 adult patients undergoing elective TAPP repair between 2021 and 2025. Patients were divided into a standard TAPP group (n=110) and an optimized protocol group (n=118). The optimized protocol incorporated atraumatic dissection, adequate mesh overlap (≥3–4 cm), selective mesh fixation, meticulous peritoneal closure, and a structured enhanced recovery pathway. Statistical analysis was performed using IBM SPSS Statistics v27. Continuous variables were analyzed using Student’s t-test or Mann–Whitney U test; categorical variables using χ² test. Recurrence-free survival was assessed by Kaplan–Meier analysis. Multivariate logistic regression identified independent predictors of postoperative complications. A post hoc power analysis was conducted. Results: Baseline demographic and clinical characteristics were comparable between groups (p>0.05). The optimized protocol significantly reduced overall postoperative complications (11.8% vs 4.9%, p=0.031), seroma formation (8.6% vs 3.1%, p=0.028), and chronic pain at 6 months (6.2% vs 2.4%, p=0.041). Kaplan–Meier analysis demonstrated improved recurrence-free survival in the optimized group (log-rank p=0.048). Multivariate analysis identified large scrotal hernia (OR 2.41, 95% CI 1.18–4.92, p=0.015), BMI ≥30 kg/m² (OR 1.96, p=0.047), and routine mesh fixation (OR 2.12, p=0.036) as independent risk factors, while the optimized protocol was independently protective (OR 0.38, p=0.021). Median hospital stay decreased significantly (2.1 ± 0.6 vs 1.4 ± 0.5 days, p