The trans-abdominal preperitoneal (TAPP) approach provides access to the contralateral groin for exploration and repair of occult hernias. Previous studies have shown that the total extraperitoneal (TEP) approach also provides access to the contralateral groin for inguinal hernia repair. The aim of the current study was to document the rate of contralateral occult inguinal hernias diagnosed during the TAPP procedure. Data from all cases of TAPP inguinal hernia repair in our hospital were recorded prospectively for 3 years. Follow-up appointments included physical examinations. A total of 302 patients underwent TAPP inguinal hernia repair. We excluded 3 patients from the study and 299 were included. A total of 204 (68%) patients were scheduled for unilateral hernia repair and contralateral occult hernias were detected in 44 (21%) patients in this group. Of the 74 patients scheduled for bilateral repair, 60 (81%) underwent bilateral repair. In the remaining 29 patients, the diagnosis was changed to unilateral hernia. In this group, unilateral hernia repair was planned along with the possibility of contralateral hernia in 18 (6%) patients. Of these patients, 5 (27%) were subsequently found to have contralateral defects, 1 of whom underwent femoral repair. Our clinical diagnoses were 78% accurate. Identifying the actual incidence of contralateral occult inguinal hernia will enhance the planning of the treatment preoperatively and favor resource allotment planning for utilization of the operating room. TAPP allows preoperative diagnosis and treatment of contralateral occult hernias, saving the patient from additional symptoms and reoperations.
Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study
