Comparison of laparoscopic iliopubic tract repair and transabdominal preperitoneal hernioplasty for contralateral occult inguinal hernia.

PURPOSE: Metachronous contralateral inguinal hernia (MCIH) following unilateral inguinal hernia repair is a common cause of reoperation. Contralateral occult inguinal hernia (OIH) may cause MCIH. Transabdominal preperitoneal hernioplasty (TAPP) might be overtreatment for OIH repair; laparoscopic iliopubic tract repair (IPTR) may be an effective alternative but has not been robustly studied. We compared laparoscopic IPTR and TAPP in treating OIH.

METHODS

This retrospective observational cohort study included 701 patients aged ≥ 18 years who received treatment for inguinal hernia between September 2012 and December 2023; 90 patients were excluded owing to loss during follow-up. Patients were divided into TAPP (54 patients; mesh implantation) and laparoscopic IPTR (647 patients; suture of the iliopubic tract and transversalis fascia arch without mesh implantation) groups.

RESULTS

MCIH from repaired OIH occurred in one patient in the TAPP group and six patients in the IPTR group [1.9% (1/54) vs. 0.9% (6/647), respectively]; this difference was not significant. The postoperative complication rate was higher in the TAPP group than in the IPTR group [5.6% (3/54) vs. 0.8% (5/647), p < 0.001]. Inguinodynia occurred in one patient in each group. Postoperative pain scores, duration of hospitalization, and time to return to normal daily life did not differ significantly between groups.

CONCLUSION

Laparoscopic IPTR is safe and effective for treating OIH and presents a viable alternative to TAPP.