ENHANCED POSTOPERATIVE RECOVERY AND RISK FACTORS FOR CHRONIC INGUINAL PAIN FOLLOWING MODIFIED TAPP HERNIOPLASTY

Abstract

Postoperative pain, delayed functional recovery, and chronic inguinal pain remain clinically important after inguinal hernia repair. Objective: To compare recovery outcomes following modified transabdominal preperitoneal (TAPP) hernioplasty, conventional TAPP, and open Lichtenstein repair and identify factors associated with prolonged hospitalization and chronic pain. A comparative observational analysis included 252 patients undergoing inguinal hernia repair: conventional TAPP (n=72), modified TAPP (n=70), and Lichtenstein repair (n=110). The modified approach incorporated reduced penetrating mesh fixation, preferential atraumatic adhesive fixation, and optimized peritoneal closure. Pain scores, analgesic consumption, mobilization, hospitalization, functional recovery, and longer-term outcomes were evaluated. Multivariable logistic regression assessed selected risk factors. Pain at 6 hours was 4.6±1.1, 4.0±1.1, and 5.8±1.2 points, respectively (p<0.001). Median morphine-equivalent analgesic consumption was 20.9, 16.6, and 30.7 mg (p<0.001). Mobilization occurred after 9.1±2.6, 7.8±1.9, and 14.2±3.6 hours (p<0.001); median hospitalization was 2.5, 2.4, and 3.5 days (p<0.001). Return to work occurred after a median of 13.2, 10.6, and 21.6 days (p<0.001). Chronic pain at 6 months (VAS≥3) occurred in 6.9%, 4.3%, and 16.4% (p=0.018). Tack fixation was associated with higher adjusted odds of chronic pain (aOR 2.52; 95% CI 1.06–6.02), whereas modified TAPP was associated with lower odds versus Lichtenstein repair (aOR 0.24; 95% CI 0.07–0.82). Modified TAPP was associated with favorable recovery measures and reduced chronic pain; nonrandomized comparisons warrant cautious causal interpretation.