Abstract:

Background: Transabdominal preperitoneal (TAPP) inguinal hernia repair has become a preferred minimally invasive approach worldwide. Although it offers reduced postoperative pain, rapid recovery, and improved cosmetic outcomes compared with open repair, TAPP is associated with unique technical challenges due to the complex anatomy of the myopectineal orifice and the requirement for precise preperitoneal dissection.

Objective: This review aims to comprehensively evaluate contemporary evidence related to patient-related, surgical, and perioperative risk factors for complications following TAPP repair and summarize validated strategies to minimize both early and late postoperative complications.

Methods: A structured literature review was performed in Scopus, PubMed, Web of Science, and Cochrane Library, focusing on publications from January 2020 to June 2024. Studies included randomized controlled trials, cohort studies, meta-analyses, and international guidelines.

Results: The strongest predictors of complications include obesity, smoking, large/scrotal hernias, inadequate mesh coverage, technical errors in dissection, and surgeon experience below the threshold of 50 procedures. Evidence suggests that standardization of operative steps, atraumatic mesh fixation, proper identification of anatomical landmarks, and enhanced perioperative care significantly decrease recurrence and chronic pain rates. ERAS protocols and regional anesthesia techniques further reduce early postoperative morbidity.

Conclusion: Most complications following TAPP repair are preventable through adherence to evidence-based protocols, optimization of patient factors, and comprehensive surgical training. A structured institutional approach ensures safe implementation and durable long-term outcomes.