Abstract
Background:
Small bowel obstruction following laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is rare and most often results from internal herniation through a peritoneal defect. Data describing its presentation and management are limited. This study aimed to characterize this complication.
Methods:
A single-center retrospective study was conducted, including all patients who underwent elective laparoscopic TAPP inguinal hernia repair between January 2021 and January 2026. Patients who developed postoperative small bowel obstruction due to internal herniation through a peritoneal defect were identified. Clinical presentation, imaging, operative findings, and outcomes were analyzed using descriptive statistics.
Results:
A total of 1927 unilateral and 531 bilateral repairs were performed. Five patients (0.2%) developed small bowel obstruction due to peritoneal defect herniation. All cases occurred after bilateral repair. Median age was 60 years (range: 37 to 77), and all patients were discharged on postoperative day 1 after an initially uneventful course. Most patients presented within the first few postoperative days with abdominal pain, nausea, and vomiting; one patient presented on day 23. Diagnosis was established by computed tomography in 4 cases and by clinical and abdominal x-ray findings in 1 patient. All patients underwent urgent laparoscopic exploration within 6 hours. The herniated bowel was reduced without resection, and the defect was closed laparoscopically. Median operative time was 49 minutes (range: 31 to 57). Recovery was uneventful, with a median hospital stay of 3 days (range: 2 to 4). At a median follow-up of 38 months (range: 2 to 62), no recurrence or readmissions were observed.
Conclusions:
Small bowel obstruction due to internal herniation through a peritoneal defect is a rare but likely underreported and preventable complication after TAPP repair. It typically presents early after an initially uneventful course. Meticulous peritoneal closure may reduce risk. Early laparoscopic re-exploration is both diagnostic and therapeutic and is associated with excellent outcomes.