Comparative study of free vas deferens separation for repair of inguinal hernia and transabdominal preperitoneal prosthesis for adult males.

Background: Laparoscopic inguinal hernia repair is now widely performed worldwide. However, there is no consensus on the most appropriate surgical operation for inguinal hernia in adult males. This study aims to evaluate the clinical efficacy and applicability of laparoscopic free vas deferens separation with transabdominal preperitoneal (LFVD-TAPP) repair for inguinal hernia in adult males, in comparison to the conventional transabdominal preperitoneal prosthesis (TAPP) approach.

Methods: A retrospective analysis was conducted on 189 adult male patients who underwent laparoscopic inguinal hernia repair at the First Affiliated Hospital of Soochow University between February 2020 and January 2023. Patients were divided into two groups that included the LFVD-TAPP (n = 95) and the conventional TAPP (n = 94). Observation targets included surgical and postoperative recovery, complication rates, recurrence and chronic pain. Data were analyzed using SPSS 27.0, with statistical significance defined as p < 0.05.

Results: No significant differences were found in baseline characteristics between groups. The LFVD-TAPP group showed significantly shorter operative times for both unilateral and bilateral hernias compared to the TAPP group (0.97 ± 0.20 h vs. 1.60 ± 0.21 h; 1.21 ± 0.17 h vs. 2.01 ± 0.30 h; P < 0.001). No significant differences were observed in postoperative blood loss, length of hospital stay, or hospitalization costs (P > 0.05). However, the LFVD-TAPP group exhibited a higher incidence of temporary groin induration (11 vs. 4; P < 0.05),but significantly lower rates of scrotal hematoma (5 vs. 17; P < 0.05), and chronic pain (6 vs. 11; P < 0.05). No differences were observed in other complications or recurrence rates. Follow-up over 12-24 months revealed no cases of ischemic orchitis, testicular atrophy, or ejaculatory dysfunction in the LFVD-TAPP group.

Conclusions: LFVD-TAPP presents clinical advantages over conventional TAPP, including simplified intraoperative separation, reduced surgical difficulty, and lower rates of postoperative scrotal hematoma and chronic pain, without increasing the risk of recurrence. Therefore, the LFVD-TAPP provides better protection of the vas deferens, suggesting its potential for clinical application and broader promotion.