ArticleHernia : the journal of hernias and abdominal wall surgery2025
Recurrence after implementation of an updated intraoperative protocol for totally extraperitoneal (TEP) inguinal hernia repair in a high-volume clinic - a retrospective cohort study.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Inguinal hernia repair with the trabucco technique: A multicenter analysis with 5-year follow-up.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
purposeAlthough the recurrence rate after inguinal hernia repair is low, it remains an important postoperative outcome. To further reduce this rate, modifiable risk factors should be addressed. This study assessed reoperations for recurrence-like complaints following adjustments to the intraoperative protocol aimed at preventing recurrent inguinal hernias. These adjustments included fixating mesh in large unilateral direct defects and large bilateral hernias, and thoroughly reducing inguinal lipomas.
methodsElective totally extraperitoneal (TEP) repairs in adults performed between January 1, 2013, and October 25, 2023, were retrospectively included. The cohort was subsequently divided into two groups based on the timing of their TEP repair: before (pre-implementation) or after (post-implementation) the protocol adjustments. The primary outcome was reoperation for recurrence-like complaints following the initial TEP repair. Secondary outcomes included mesh fixation and lipoma reduction.
resultsA total of 12,878 TEP repairs in 12,507 patients were included (pre-implementation: 5,454; post-implementation: 7,424). Reoperation rate decreased from 0.97% pre-implementation to 0.65% post-implementation (p = 0.630). Following protocol implementation, mesh fixation for unilateral hernias significantly increased from 3.2% to 5.4% (p < 0.001), and for bilateral hernias from 9.8% to 16.3% (p < 0.001). Lipoma reduction was similar between the groups (unilateral: 32.3-32.6%, p = 0.625; bilateral: 36.0-38.1%, p = 0.288).
conclusionThe adjusted intraoperative protocol demonstrated a non-significant declining trend of reoperations for recurrence-like complaints. Lipoma reduction was already well-implemented. While mesh fixation increased, it had no significant effect on the recurrence rate, so careful selection of hernias requiring fixation warrants attention.
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