Outcomes after laparoscopic transabdominal preperitoneal (TAPP) hernia repair in the emergency: A matched case-control study

Abstract

Introduction: Laparoscopic repair of groin hernia (LRGH) is widely accepted for elective cases, but its use in emergency cases remains controversial. We aimed to compare postoperative outcomes between elective and emergent transabdominal preperitoneal (TAPP) repairs. Materials and Methods: Patients undergoing emergent LRGH (EM-LR) using a TAPP technique between June 2014 and December 2019 were included for analysis. A case-control cohort of patients undergoing elective LRGH (EL-LR) in the same period was identified and matched (1:3) on gender, age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, active smoking, and hypertension. Preoperative variables and postoperative outcomes were compared between both groups. Results: A total of 15 EM-LR were matched with 45 EL-LR. In patients undergoing EM-LR, the median time from onset of symptoms to surgery was 12 (1–168) h. No differences were found regarding the operative time (EM-LR: 107 min vs. EL-LR: 117 min, P = 0.37) and hernia defect size (EM-LR: 3.6 cm vs. EL-LR: 4.1 cm, P = 0.48). Although small bowel obstruction was observed in all emergent cases, no patients required enterectomy. Emergent cases were performed more frequently by specialist surgeons (EM-LR: 87% vs. EL-LR: 24%, P < 0.001). Mean hospital stay was 3.1 and 0.3 days after EM-LR and EL-LR, respectively (P < 0.001). Overall 30-day morbidity was similar between groups (EM-LR: 6.6% vs. EL-LR: 4.4%, P = 0.43). After a mean follow-up of 28.2 months, no recurrence was observed. Conclusion: EM-LR had similar overall morbidity and recurrence rates than elective repairs. Prompted surgical exploration and use of laparoscopy should be encouraged for the management of complicated inguinal hernias.