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. 2025 May 15;29(1):164.
doi: 10.1007/s10029-025-03327-6.

Recurrence after implementation of an updated intraoperative protocol for totally extraperitoneal (TEP) inguinal hernia repair in a high-volume clinic - a retrospective cohort study

R R Meuzelaar  1   2 , A H W Schiphorst  3 , J P J Burgmans  3
Affiliations

Recurrence after implementation of an updated intraoperative protocol for totally extraperitoneal (TEP) inguinal hernia repair in a high-volume clinic - a retrospective cohort study

R R Meuzelaar et al. Hernia. .

Erratum in

Abstract

Purpose: Although 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.

Methods: Elective 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.

Results: A 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).

Conclusion: The 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.

Keywords: Lipoma reduction; Mesh fixation; Recurrence rate; Totally extraperitoneal repair.

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Conflict of interest statement

Declarations. Competing interests: R.R. Meuzelaar, A.H.W. Schiphorst and J.P.J. Burgmans declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of inclusions. TAPP, transabdominal preperitoneal; TEP, totally extraperitoneal
Fig. 2
Fig. 2
Kaplan-Meier survival curve with recurrence-free survival estimates and risk table
See this image and copyright information in PMC

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References

    1. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571. 10.1016/S0140-6736(03)14746-0 - PubMed
    1. Central Bureau of Statistics CBS (2014) Statline: Surgeries in the hospital; type of admission, age, and gender, 1995–2010. https://opendata.cbs.nl/statline/#/CBS/nl/dataset/80386NED/table?fromsta.... Accessed on 21 Nov. 2023
    1. Lockhart K, Dunn D, Teo S, Ng JY, Dhillon M, Teo E, van Driel ML (2018) Mesh versus non-mesh for inguinal and femoral hernia repair. Cochrane Database Syst Rev 9:CD011517. 10.1002/14651858.CD011517.pub2 - PMC - PubMed
    1. Kockerling F, Jacob D, Wiegank W, Hukauf M, Schug-Pass C, Kuthe A, Bittner R (2016) Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: are there differences in the outcome? Surg Endosc 30:1146–1155. 10.1007/s00464-015-4318-3 - PMC - PubMed
    1. Scheuerlein H, Schiller A, Schneider C, Scheidbach H, Tamme C, Kockerling F (2003) Totally extraperitoneal repair of recurrent inguinal hernia. Surg Endosc 17:1072–1076. 10.1007/s00464-002-8957-9 - PubMed

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