Risk factors associated with inguinal hernia recurrence after single-incision laparoscopic totally extraperitoneal repair.

Abstract

Purpose: This study aimed to identify risk factors contributing to recurrence after single-incision laparoscopic totally extraperitoneal (SILTEP) inguinal hernia repair.

Methods: A retrospective analysis was performed on the medical records of patients who underwent SILTEP repair performed by a single surgeon between 2016 and 2021. The learning curve for the procedure was assessed using the moving average method and a cumulative sum (CUSUM) control chart based on operative times. Intraoperative complications were defined as events requiring additional port placement, peritoneal tears, conversion to open surgery, or visceral or vascular injuries.

Results: A total of 180 patients underwent SILTEP repair during the study period, of whom 172 met the inclusion criteria for analysis. Recurrence occurred in 12 patients (7.0%). The CUSUM analysis revealed an inflection point at 30 cases, indicating stabilization of operative times to under 57 min. The first 30 cases were categorized as the learning phase. Univariate analysis identified several factors associated with recurrence, including the learning period, recurrent hernia, operative time exceeding 57 min, intraoperative blood loss > 20 cc, and the presence of intraoperative complications. However, multivariate analysis revealed that intraoperative complications were the sole independent predictor of recurrence after SILTEP repair (hazard ratio, 13.38; p = 0.03).

Conclusions: Intraoperative complications were identified as the only independent risk factor for recurrence after SILTEP repair. These findings highlight the need to minimizing intraoperative complications to improve outcomes and reduce recurrence rates in patients undergoing SILTEP repair.