ArticleHernia : the journal of hernias and abdominal wall surgery2026
To close or not to close the deep inguinal ring in laparoscopic hernia repair. A comparative study.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeClosing the deep inguinal ring (DIR) in laparoscopic inguinal hernia repair (LIHR) is a potential alternative to improve surgical outcomes, however, its implementation remains controversial. We aimed to compare postoperative results after DIR closure in laparoscopic TAPP repair for large indirect inguinal hernias.
methodsA retrospective analysis was conducted in patients who underwent LIHR with indirect defects ≥ 3 cm (L3 according to the European Hernia Society classification) between January 2022 and December 2024. Patients were divided into two groups: closed ring repair (CRR) and standard repair (SR) group. Demographic, intraoperative, and postoperative variables were analyzed.
resultsA total of 177 laparoscopic TAPP repairs with L3 defects were included for analysis. Seventy-two repairs were in the CRR group and 105 in the SR group. Defect area was significantly larger in CRR group (CRR: 15.7 cm² vs. SR: 13.9 cm²; p = 0.02). Mesh fixation was less frequently required in CRR group (CRR: 56% vs. SR: 90.5%; p < 0.0001), and when fixation was used, fewer tackers were applied (CRR: 3.2 vs. SR: 4.7; p < 0.0001). Postoperative pain was significantly lower in CRR group at 1 week (VAS CR: 0.71 vs. SR: 1.63; p = 0.01) and at 1 month (VAS CRR: 0.19 vs. SR: 0.58; p = 0.04). After a mean follow-up of 15 (9-25) months, only one recurrence was observed in the SR group.
conclusionsClosing the deep inguinal ring in laparoscopic inguinal TAPP repair for L3 defects is safe. It was associated with a significant reduction of acute postoperative pain scores and mesh fixation requirements.
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