One surgeon’s experience with r-TAPP: a retrospective analysis of 150 consecutive robotic inguinal hernia cases

There is a tremendous paucity of literatures regarding the long-term surgical outcomes of the r-TAPP procedure for inguinal hernia repair. Additionally, much of the existing literatures regarding this procedure have limited follow-up of to 12 months. This article presents the outcomes of 150 consecutive r-TAPP inguinal hernia repairs performed on 111 patients using Progrip mesh without fixation, with up to 24 months of follow-up. The initial 150 consecutive r-TAPP inguinal hernia repairs were performed from February 2017 to April 2018 using Progrip without fixation. All patients were seen at 2 weeks, followed by phone follow-up at 6 months, 1 year, and 2 years. Of the 111 patients, 39 had bilateral hernias (35%) and 72 had unilateral hernias (65%). The age range was 18–93 years. The BMI range was 20.7–50.2, with a mean of 26.4 and median of 25.8. Total operative time ranged from 28 to 138 min with a mean of 62.4 min and median of 56 min. ASA classification ranged from 1 to 4, with a mean of 2.1. No significant blood loss was observed in any of the cases. There were no conversions to open surgery. All patients were discharged the same day of the operation. We were able to follow up with 100% of the hernias at 2 weeks, 88% at 6 months, 87% at 1 year, and 80% at 2 years. No recurrences were recorded at 2 weeks, 3 months, 6 months, 1 year, or 2 years. There were no reports of chronic pain up to 2 years in any of the patients. These results indicate that r-TAPP inguinal hernia repair using Progrip without further fixation is safe, effective, and can be performed with minimal recurrences or chronic pain.

Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair

The inguinal hernia repair is one of the most frequent surgical procedures: in the world, even year, at least 20.000.000 inguinal hernia repair procedures are performed. Although the laparoscopic approach is widely recognized as a valid treatment for many diseases and some laparoscopic surgical procedures have become gold standard techniques (e. g. cholecystectomy, appendectomy, gastro-esophageal junction surgery), the minimally invasive approach for groin hernia treatment is still very controversial today, but in the last few years, it tends to become the standard practice for 1 day surgery. We present here the technique of laparoscopic Transabdominal Preperitoneal approach (TAPP). The surgical technique is described step-by-step, including surgical details and the new concept of “inverted Y” to achieve the “critical view of safety” for laparoscopic inguinal hernia repair.