Retrospective comparison of two surgical approaches for incarcerated inguinal hernia: Midline preperitoneal repair and laparoscopic transabdominal preperitoneal (TAPP) surgery

Abstract Background：Laparoscopic treatment for incarcerated inguinal hernia has gradually increased, while more surgeons preferred open surgery. Therefore, it is necessary to analyze the safety and effectiveness of the two surgical methods.Methods: The patients with incarcerated/strangulated inguinal hernia treated in Jinshan Hospital (Shanghai, China) from January 2018 to March 2021 were retrospectively analyzed. According to different surgical approaches, the patients were divided into lower abdominal midline incision group (LAMI) and laparoscopic transabdominal preperitoneal (TAPP) group. The characteristics, surgical outcomes and postoperative complications of the two groups were compared retrospectively.Results: 104 incarcerated/strangulated inguinal hernia cases were included in total. The average age was 64.4±16.8 years, 79 of them (76.0%) were male. 44 cases (42.3%) had obvious intestinal obstruction, and a total of 27 cases (26.0%) underwent intestinal resection. There were 62 cases (59.6%) in the LAMI group and 42 cases (40.4%) in the TAPP group. The operation time in the TAPP group was about 15 minutes longer (107.0min versus 92.8min; P =0.012), but postoperative length of hospitalization and time of return to normal activity were shorter in the TAPP group (2.7days versus 6.8days P<0.001 and 8.1 days versus 13.6days; P<0.001). There were 83 cases (79.8%) of 1st stage tension-free herniorrhaphy, including 37 cases (88.1%) in the TAPP group and 46 cases (74.2%) in the LAMI group (P=0.083). The surgical complications such as incision infection (4.8% versus 0 P=0.396), seroma/hematomas (11.3% versus 9.5%, P=1.000), intra-abdominal infection (16.1% versus 2.4% P=0.056), and recurrence (1.6% versus 0 P=1.000) were similar in the two groups. There were no cases of patch infection and chronic pain in the two groups. A total of 2 cases (1.9%) died of multiple organ dysfunction in the LAMI group and no death in the TAPP group.Conclusions: Lower abdominal midline incision approach and TAPP were safe and effective in the treatment of incarcerated inguinal hernia. TAPP showed more favorable short-term results for cases that were easy to retract without intestinal resection. Midline preperitoneal repair was more suitable for strangulated hernia requiring intestinal resection.