3D Laparoscopic TAPP repair for incarcerated and strangulated inguinal hernias: A prospective cohort study

Abstract

Background: Evidence regarding three-dimensional (3D) laparoscopic transabdominal preperitoneal (TAPP) repair with anatomical mesh for incarcerated and strangulated inguinal hernias remains limited. This study evaluated perioperative and follow-up outcomes of this approach in a selected cohort. Methods: A prospective single-center longitudinal cohort study included 105 eligible adults with incarcerated or strangulated inguinal hernias who underwent 3D laparoscopic TAPP repair at Hue Central Hospital from June 2022 to June 2025. Patients with peritonitis or bowel necrosis requiring resection were excluded. All enrolled patients completed TAPP. No bowel resection, primary open operation, or conversion to open surgery occurred. Clinical, operative, postoperative, and protocol-defined follow-up outcomes were analyzed. Exploratory subgroup comparisons used the Mann-Whitney U and Fisher’s exact tests. Results: The mean age was 57.1 ± 17.0 years and 96.2% were male. There were 68 incarcerated hernias treated electively and 37 strangulated hernias treated as emergencies. Ten patients underwent bilateral repair after contralateral hernias were identified intraoperatively. Mean operative time was 82.6 ± 29.8 minutes. Hernia contents were preserved in 104/105 patients (99.0%, 95% CI, 94.8%-99.8%). One patient required partial omentectomy and no bowel resection was performed. Early postoperative complications occurred in 3/105 patients (2.9%, 95% CI, 1.0%-8.1%). Within 24 hours, 81.9% passed flatus and 65.7% resumed independent ambulation. Mean postoperative stay was 3.5 ± 1.2 days, and 97.1% reported returning to normal activities within 14 days. At the protocol-defined assessment at or after 6 months, all patients completed clinical examination and ultrasonography, while 99 underwent computed tomography. Six patients did not return for scheduled computed tomography. No recurrence, surgical-site infection, or mesh-related infection was identified during this limited follow-up. Conclusion: In selected patients without peritonitis or bowel necrosis requiring resection, 3D laparoscopic TAPP repair with anatomical mesh was feasible and was associated with favorable perioperative and short-term outcomes during limited follow-up. These findings should not be generalized to contaminated surgical fields, patients requiring bowel resection, or the broader population of acute irreducible groin hernias.