A Prospective Evaluation of Laparoscopic Inguinal Hernia Repair Outcomes at Tobruk Medical Center, Libya

Abstract

Inguinal hernias are among the most common surgical pathologies worldwide, with laparoscopic Transabdominal Preperitoneal (TAPP) repair emerging as a preferred minimally invasive technique. However, continuous evaluation of short-term outcomes and identification of modifiable risk factors for postoperative complications remain essential for optimizing patient care. This study aimed to evaluate the clinical outcomes and identify independent predictors of complications following laparoscopic TAPP inguinal hernia repair.  This prospective observational study was conducted at the Department of General Surgery, Tobruk Medical Center, Libya, over two years from 2023 to 2024. A total of 60 patients diagnosed with primary inguinal hernias and medically fit for general anesthesia underwent TAPP repair. Patients with irreducible/obstructed hernias, previous lower abdominal surgeries, recurrent hernias, severe cardiopulmonary comorbidities, or those lost to follow-up were excluded. All participants were monitored postoperatively for complications, pain scores (using the Numeric Rating Scale), and hernia recurrence over a one-year follow-up period. Multivariate logistic regression analysis was performed to identify independent predictors of overall complications. The mean patient age was 44.9 ± 12.5 years, and the mean BMI was 24.8 ± 1.36 kg/m². The mean operative time was 73.2 ± 8.3 minutes. Patients demonstrated rapid recovery, with a mean hospital stay of 31.5 ± 5.1 hours and a mean return to work of 7.5 ± 1.9 days. Postoperative pain scores decreased progressively from 4.9 on day 1 to 2.7 by the first week. Only 20% of patients required ongoing analgesics. Seroma occurred in 15% of patients at day 7, resolving spontaneously to 5% by the first month. Foreign body sensation was reported in 20% of patients. No recurrences, wound infections, hematomas, or chronic pain syndromes were recorded. Multivariate analysis identified chronic cough (OR: 2.66; p = 0.001), constipation (OR: 1.50; p = 0.01), heavy lifting (OR: 2.17; p = 0.001), diabetes mellitus (OR: 1.02; p = 0.02), and smoking (OR: 1.92; p = 0.001) as independent predictors of overall postoperative complications. Laparoscopic TAPP inguinal hernia repair is a safe, feasible, and effective procedure that offers rapid recovery, low morbidity, and excellent short-term outcomes with no recurrence at one year. Modifiable risk factors, particularly smoking, chronic cough, constipation, heavy lifting, and diabetes mellitus, should be systematically addressed preoperatively to minimize complication rates and optimize surgical success.