FEATURES OF TRANSABDOMINAL PREPERITONEAL PLASTIC SURGERY ( TAPP )

INTRODUCTION

Inguinal hernia repair is a common procedure performed by general surgeons. The main technique for inguinal hernia repair is open surgery using mesh implants. The introduction of totally extraperitoneal hernia repair (TEP) and transabdominal preperitoneal repair (TAPP) in the early 1990s opened a new chapter in inguinal hernia surgery. Laparoscopy was found to be the answer to minimize the impact of preperitoneal open techniques. Minimally invasive techniques versus open surgeries have become a hot topic of discussion among surgeons. Over time, the number of procedures and indications has increased and continues to increase.

Objective: To evaluate the features of transabdominal preperitoneal plastic surgery in residents of the Perm region.

Materials and methods. A retrospective single-center non-randomized study was performed. The medical records of patients operated on for inguinal and femoral hernias, admitted for planned treatment to the surgical department of Perm City Clinical Hospital No. 4 for the period from January 2024 to February 2025, were reviewed. All patients underwent transabdominal preperitoneal plastic surgery of hernia defects. Hernias were classified intraoperatively based on the laparoscopic picture using the classification of inguinal hernias of the European Hernia Society (EHS) .

Results. The final group included 29 patients, 10.3% (3 people) were female, 90.7% (26 people) were male. The average age was 57.2 ± 10.1 years (from 36 to 76 years), the median was 56 years. The average hospitalization period was 5.27 ± 1.29 bed-days.

Primary inguinal hernias (P) were observed in 24 patients (82.8%), recurrent (R) in 5 (17.8%). Lateral/oblique hernia (L) occurred in 6 patients (20.7%), medial/direct hernia (M) in 22 patients (75.9%) and femoral hernia (F) in 1 patient (3.4%).

The size of the hernial orifice in 21 patients (72.4%) was ≤1.5 cm (1 according to the EHS classification), in 7 patients (24.1%) from 1.5 cm to 3 cm (2 according to the EHS classification) and in 1 patient (3.4%) more than 3 cm (3 according to the EHS classification). In 23 patients (79.3%) there was a unilateral hernia. Bilateral hernia was observed in 6 patients (20.7%).

Simultaneous surgery was performed in 8 patients (27.6%). Transabdominal preperitoneal plastic surgery and hernioplasty of umbilical hernia were performed in 4 patients: with a mesh implant (2 patients) and according to the Mayo method (2 patients). Transabdominal preperitoneal plastic surgery was performed on both sides in three patients. Laparoscopic cholecystectomy was performed as the first stage and transabdominal preperitoneal plastic surgery as the second stage in two patients.

Conclusions.

Inguinal hernia is a common clinical condition, with a lifetime incidence of 27% in men and 3% in women. Surgical treatment is the most effective treatment. It is estimated that more than 20 million inguinal hernia surgeries are performed worldwide each year, making it one of the most common surgical procedures in the world. Inguinal hernia surgery includes open surgery and laparoscopic surgery. For young patients with inguinal hernia, surgical treatment using endoscopic technology is recommended. [1]

With TAPP, it is possible to perform a simultaneous operation through the same surgical approach. The combination of the two procedures is safe and does not increase the likelihood of postoperative infections, especially with prophylactic use of antibiotics to reduce the likelihood of surgical site infection. [2] For example, in our study, 3 patients with bilateral inguinal hernia underwent hernioplasty on both sides through one approach, and 2 patients underwent first-stage laparoscopic cholecystectomy followed by transabdominal preperitoneal inguinal hernia repair. By slightly widening the infraumbilical approach, it is possible to perform umbilical hernia repair. In our study, 4 patients underwent umbilical hernia repair after TAPP: 2 using the Mayo technique and the remaining 2 using mesh implants.

In case of recurrent hernias, in which the normal anatomy of the inguinal region is already disrupted, as well as in controversial cases, when it is not possible to reliably determine the presence of an inguinal or femoral hernia, TAPP is the operation of choice. When studying the medical records of patient O., 48 years old, it was revealed that the patient had previously undergone surgery for an inguinal hernia on the left in 2022 (Lichtenstein operation). She re-noted a hernial protrusion on her own in 2023. During physical and ultrasound examination of the inguinal areas, a hernial protrusion was not determined, but laparoscopy revealed a small canal femoral hernia on the left side, TAPP was performed using the standard technique. In the postoperative period, the patient no longer noted hernial protrusions. She was discharged in a satisfactory condition.

Minimally invasive TAPP is associated with significant reductions in early postoperative pain, chronic pain, hematoma, wound infection, and early return to normal activities and work compared with open inguinal hernia repair. Hernia recurrence, seroma, and length of hospital stay are similar when these treatments are compared. [2]

References:

1. Kiriyenko A.I., Shevtsov Yu.N., Nikishkov A.S., Seliverstov E.I., Andryashkin A.V., Tatarintsev A.M., Zolotukhin I.A. Prevalence of hernias of the anterior abdominal wall: results of a population study. Surgery. Journal im. N.I. Pirogov. 2016;(8):61 - 66.
2. Arafat S, Alsabek MB. Simultaneous laparoscopic cholecystectomy and transabdominal preperitoneal hernioplasty: two case reports evaluate the safety and surgical complications. Clin Case Rep. 2017 Nov 9;5(12):2093-2096. doi: 10.1002/ccr3.1141. PMID: 29225864; PMCID: PMC5715574.
3. Aiolfi A, Cavalli M, Ferraro SD, Manfredini L, Bonitta G, Bruni PG, Bona D, Campanelli G. Treatment of Inguinal Hernia: Systematic Review and Updated Network Meta-analysis of Randomized Controlled Trials. Ann Surg. 2021 Dec 1;274(6):954-961. doi: 10.1097/SLA.0000000000004735. PMID: 33427757.