Feasibility of Transabdominal Preperitoneal Combined With Internal Ring Constriction in Treating Giant Inguinal Hernia.

Objective: This study aimed to evaluate the clinical efficacy, technical characteristics, and impact on postoperative recurrence of the transabdominal preperitoneal (TAPP) approach combined with internal ring constriction for the treatment of giant inguinal hernias.

Materials and methods: Conducted as a single-blinded, single-center randomized controlled trial, the study compared TAPP with and without internal ring constriction. A total of 962 patients with inguinal hernias were recruited from January 2020 to October 2023. Based on the European Hernia Society classification, 779 patients with type I or II hernias were excluded, leaving 183 patients with type III inguinal hernias (inner ring defect ≥3 cm) for analysis. The experimental group (n=93) received TAPP combined with internal ring constriction, while the control group (n=90) underwent standard TAPP. Key outcomes assessed included operation time, intraoperative bleeding, postoperative pain, hospital stay duration, postoperative complications, and the 2-year recurrence rate.

Results: The experimental group had a significantly longer operation time than the control group (P<0.001). However, no significant differences were observed between the groups regarding intraoperative bleeding, hospital stay length, postoperative pain (measured by the visual analog scale on the first postoperative day), surgical site infection, seroma, scrotal edema, or vascular injury (all P values >0.05). Notably, neither group experienced scrotal hematoma or hydrocele. The experimental group demonstrated a significant reduction in the 2-year recurrence rate compared with the control group (P<0.05).

Conclusions: These findings suggest that TAPP combined with internal ring constriction is a valuable technique in managing giant inguinal hernias, offering a lower postoperative recurrence rate without increasing perioperative complications, postoperative pain, or hospital stay duration.