Herniology is one of the most dynamically evolving fields of modern surgery, both in Ukraine and abroad. This is primarily due to the high prevalence of abdominal wall hernias, particularly inguinal hernias, which constitute approximately 70–80% of all hernial cases. According to WHO data, inguinal hernias affect about 3–6% of the population, with the incidence reaching 6–7% among men and about 2.5% among women [73, 110].
Surgery remains the primary treatment for this pathology. Hernia repairs account for 15 to 25% of all surgical interventions [17], with inguinal hernia repairs constituting approximately 75% of these [50]. For instance, around 100,000 patients with inguinal hernias undergo surgical treatment annually in the United Kingdom alone [19]. Numerous surgical techniques have been developed, among which the Lichtenstein procedure is considered the "gold standard". However, with the advancement of endovideosurgery, the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair techniques are gaining prominence. The laparoscopic approach for inguinal hernia repair offers several advantages, including reduced postoperative complications, decreased postoperative pain, shorter hospitalization periods, reduced treatment costs, and quicker return to work. Drawbacks of this method include higher direct costs, the necessity for general anesthesia, and the requirement for surgeons to adapt to the "new" anatomy of the posterior inguinal wall from a laparoscopic perspective, which may be unfamiliar to general surgeons.
The key criteria for evaluating surgical effectiveness remain postoperative pain levels and recurrence rates. Literature reports recurrence rates as high as 30–35% [1, 4]. Chronic postoperative pain is frequently associated with nerve damage due to fixation elements such as staples, sutures, and tacks [70]. Equally important is adherence to surgical safety principles, as peritoneal dissection near nerve trunks may result in persistent neuropathic pain [20].
The guidelines of the European Hernia Society (EHS, 2014) recommend the mandatory use of mesh implants for abdominal wall defects larger than 2 cm or in recurrent hernias [17]. Nevertheless, the optimal method for mesh fixation remains undefined, particularly within Ukrainian clinical practice.
Despite numerous studies comparing various hernioplasty techniques, mesh types, and fixation methods, the issues of postoperative pain and recurrence remain unresolved. These unresolved issues have provided the basis for conducting this study.
Objective of the study:
Improving the effectiveness of transabdominal preperitoneal hernioplasty for inguinal hernias through the development and implementation of a treatment algorithm.
Research objectives:
1. To investigate the anatomical features of the inguinal region in patients with inguinal hernias of varying sizes.
2. To optimize the TAPP hernioplasty technique without mesh fixation and to determine the clinical indications for its application.
3. To substantiate the rationale for anatomical mesh fixation in large inguinal hernias.
4. To perform a comparative assessment of the effectiveness of laparoscopic TAPP hernioplasty with and without mesh fixation.
5. To evaluate the immediate clinical outcomes of laparoscopic TAPP hernioplasty with and without mesh fixation.
