Prospective Evaluation of the Economic Benefit of Laparoscopic Transabdominal Pre-peritoneal (TAPP) Hernia Repair in the Detection of Occult Bilateral Inguinal Hernias

A Patel, MD MRCS, D Vandellen, MD FRCS, M S Wadley, MD FRCS. Department of Surgery, Worcestershire Royal Hospital, Worcester, UK


INTRODUCTION: The aim of our study was to determine the incidence and the potential economic benefit of the detection of occult bilateral hernias during laparoscopic inguinal hernia repair. In the UK many authorities recommend laparoscopic repair for bilateral and recurrent inguinal hernias only with TEP being the preferred approach in many centres. The TAPP approach however enables detection and simultaneous treatment of occult bilateral hernias undiagnosed in the outpatient setting.
METHODS: This is a prospective review of patients undergoing TAPP hernia repair by a single surgeon from October 2002 to May 2011. Patient demographics, intra-operative findings, length of hospital stay and details of post-operative follow-up were recorded. Routine laparoscopic TAPP repair was performed with mesh fixation. Consent was obtained prior to the procedure for the repair of contralateral hernias if detected intra-operatively.
RESULTS: 329 TAPP repairs (183 unilateral; 73 bilateral; 34 recurrent) were performed in 254 patients (248 male; 6 female; median age 55 yrs; range 17-90). In 31 (14%) patients listed with unilateral hernias, occult bilateral hernias were diagnosed. The median operating time for unilateral hernias was 38 minutes (range 18-67) and 55 minutes (range 32-90) for bilateral hernias. Extrapolating savings based on patient numbers, theatre costs and hospital stay this amounts to a potential annual saving for the local health economy of £70,000 ($110,000).
CONCLUSIONS: TAPP repair offers advantages over the TEP/open approach as it enables detection of occult hernias without further dissection of tissue planes. It avoids the potential risks and additional costs of further surgery and we recommend it also be considered for unilateral inguinal hernia repair.

Session Number: Poster – Poster Presentations
Program Number: P297
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