Clinical outcomes of concurrent repair of occult contralateral inguinal hernias during TAPP: a retrospective cohort study

Background To evaluate the clinical efficacy and surgical safety of intraoperative exploration and immediate repair of occult inguinal hernia (OIH) during transabdominal preperitoneal (TAPP) repair. Methods A retrospective analysis was conducted on the clinical data of 238 adult patients who underwent TAPP at Jiangsu Provincial People’s Hospital (The First Affiliated Hospital with Nanjing Medical University) from May 2023 to May 2024. Based on preoperative diagnosis and intraoperative exploration findings, patients were divided into three groups: the unilateral group (without OIH, n = 173), the OIH group (intraoperatively explored and repaired, n = 32), and the preoperative bilateral group ( n = 33). Operative time, total hospitalization costs, and the incidence of postoperative complications (including pain, seroma, urinary retention, and recurrence) were compared among the three groups. Results Among patients preoperatively diagnosed with unilateral hernia, the intraoperative exploration rate of OIH was 15.61% (32/205). Indirect inguinal hernia was the predominant type of OIH (71.88%). The operative time in the OIH group (112.03 ± 37.61 min) was significantly longer than that in the unilateral group ( P < 0.001), but showed no statistically significant difference compared with the preoperative bilateral group ( P = 0.258). Total hospitalization costs in the OIH group (17119.57 ± 1958.58 CNY) were significantly higher than in the unilateral group ( P < 0.001), but slightly lower than in the preoperative bilateral group ( P = 0.010). Postoperative complication analysis revealed that the incidence of acute pain in the OIH group (31.25%) was significantly higher than in the unilateral group ( P = 0.008). However, no statistically significant difference was observed when compared with the preoperative bilateral group ( P = 0.221). No statistically significant differences were observed among the three groups in the incidence of other complications, such as seroma, urinary retention, and hernia recurrence. Conclusions Routine intraoperative exploration during TAPP effectively identifies occult inguinal hernias. Concurrent laparoscopic repair of an incidentally detected OIH appears technically feasible and exhibits a favorable safety profile, without an obvious increase in major short-term postoperative complications compared with standard unilateral or bilateral repairs. These findings support concurrent repair as a feasible and safe intraoperative choice when an OIH was encountered.