Emergency Management of Groin Hernias: Laparoscopic vs Open Surgery

Overview

This retrospective single-center study compared laparoscopic TAPP and open surgical techniques for emergency groin hernia repair. The laparoscopic approach demonstrated safety and efficacy comparable to open surgery, with potential benefits in postoperative recovery.

Background

Groin hernia repair is a common surgical procedure worldwide, with over 113,000 operations reported in Italy in 2019. Minimally invasive laparoscopic techniques such as TAPP and TEP have become preferred in elective settings due to reduced pain and faster recovery. However, the role of laparoscopy in emergency cases involving incarcerated or strangulated hernias remains controversial and under-investigated. Emergency hernia surgery carries higher morbidity and mortality risks, and current guidelines do not provide clear recommendations on laparoscopic use in this context.

Data Highlights

Key Findings

• Laparoscopic TAPP was preferred unless contraindicated by patient comorbidities or presence of peritonitis.
• Both laparoscopic and open techniques were performed under general anesthesia with antibiotic prophylaxis.
• Laparoscopic approach allowed careful exploration of the abdominal cavity and hernia sac reduction with mesh placement.
• Open surgery involved Lichtenstein tension-free repair with mesh or Shouldice technique if contamination was present.
• Postoperative complications were systematically assessed using Clavien-Dindo classification and follow-up included outpatient visits and telephone contact.
• No standardized algorithm exists for emergency hernia repair technique selection, highlighting the need for surgeon discretion.

Clinical Implications

The laparoscopic TAPP technique is a feasible and safe option for emergency groin hernia repair in selected patients, offering the advantages of minimally invasive surgery. Surgeons should consider patient comorbidities and signs of peritonitis when choosing the surgical approach. Systematic postoperative monitoring is essential to detect complications early and optimize outcomes.

Conclusion

Laparoscopic TAPP repair represents an effective alternative to open surgery for emergency groin hernias, with comparable safety profiles. Further prospective studies are needed to establish standardized guidelines for surgical approach selection in emergency settings.

References

1. Italian Hernia Registry 2019 -- Hernia Repair Statistics
2. Minimally Invasive Surgery Advances -- Elective Groin Hernia Repair
3. Clavien-Dindo Classification 2004 -- Postoperative Complications
4. Current Guidelines on Emergency Hernia Repair -- Literature Review