Minimally invasive approach for inguinoscrotal hernia repair. A systematic literature review

Balla, Andrea;Sartori, Alberto;Ortenzi, Monica;Bressan, Livia;Podda, Mauro;Morales-Conde, Salvador

2025-01-01

---

Abstract

Background: This systematic review reports the presently available evidence regarding the results of the minimally invasive surgery (MIS) approach for the treatment of inguinoscrotal hernias (ISHs). Methods: After PROSPERO registration (CRD-42023493129), a search was performed in the MEDLINE, Embase, and Web of Science databases. Results: One-thousand-fifty-two patients were included (78.3% and 21.7% underwent transabdominal preperitoneal repair [TAPP] and totally extraperitoneal repair [TEP], respectively). Twenty-one complications occurred during TAPP (2.5%), and 28 occurred during TEP (12.3%). Conversion to open surgery for TAPP procedure was reported in seven patients (0.8%). TEP procedure required conversion to TAPP in 19 patients (8.3%), and open surgery in 18 patients (7.9%) (overall conversion rate 16.2%). Postoperative complication rate was 30.1% (317 patients), with 193 after TAPP repair (23.4%) and 124 after TEP repair (54.4%) (including Clavien-Dindo I-IV). Length of hospital stay ranged between one to five days after both repairs. The overall recurrence rate was 1.6% (19 recurrences), of which 12 (1.3%) and seven (2.8%) recurrences after TAPP and TEP, respectively. Conclusions: MIS approaches for ISH repair are technically challenging. TEP repair should be avoided in case of ISH repair, due to the high rate of postoperative complications, risk of conversion and recurrences.