Assessing the learning curve in laparoscopic TAPP repair for emergency inguinal hernia: a comparative study with open repair.

Emergency inguinal hernia repair presents considerable surgical challenges, with a continuous debate regarding the best approach. This study analyzes the outcomes of laparoscopic transabdominal preperitoneal (TAPP) repair in comparison to open tension-free repair, while also assessing the learning curve associated with TAPP. A retrospective study was conducted on 71 patients undergoing emergency inguinal hernia repair (33 TAPP, 38 open). Outcomes included operative time, intraoperative complications, pain scores, hospital stay, return to activity, recurrence, and learning curve analysis comparing early (first 18) vs. late (last 15) TAPP cases. Operative time was longer with TAPP (98.3 ± 9.4vs.80.3 ± 11.4 min, p = 0.006), with a 6.1% conversion rate. Visceral injuries were more common in TAPP (15.2%vs.2.6%, p = 0.058), while vascular injuries were higher in open repair (10.5%vs.3.0%, p = 0.218). TAPP had significantly lower pain scores at 6, 12, and 24 h (p < 0.05), shorter hospital stay (2.5 ± 0.5vs.4.8 ± 0.8 days, p = 0.001), and earlier return to activities (5.5 ± 0.5vs.10.5 ± 1.0 days, p = 0.001). Recurrence and readmission rates were comparable. Later TAPP cases showed shorter operative time (93.4 vs. 102.4 min, p = 0.002), no conversions, and better pain control. TAPP is a feasible emergency repair option, for selected cases, with a clear learning curve which improves outcomes after 15-18 cases. However, larger prospective studies are required to confirm these findings.