APPROXIMATION OF THE DEEP INGUINAL RING AND MANUAL MESH FIXATION IN TAPP HERNIOPLASTY AS A STRATEGY FOR PREVENTING "PSEUDO-RECURRENCE" AND CHRONIC INGUINAL PAIN

Abstract

Prolapse of the mesh prosthesis through a residual, uncorrected deep inguinal ring — clinically indistinguishable from true hernia recurrence and termed "pseudo-recurrence" — is a specific complication of TAPP hernioplasty. Concurrently, mechanical staple fixation carries a recognised risk of neuropathic injury contributing to chronic inguinal pain. This comparative study (n = 176) evaluated the efficacy of deep inguinal ring approximation (continuous Vicryl 2/0 suture to physiological diameter 1.0–1.5 cm) combined with manual absorbable-suture mesh fixation. In the control group (n = 94, standard TAPP with stapler), clinically significant pseudo-recurrence occurred in 3 patients, all with ring diameter > 2.5 cm. In the study group (n = 82), no prolapse was recorded. VAS pain scores were significantly lower at all time points (p < 0.05). Overall complication rate decreased from 18.1% to 12.2%. The combined technique is a safe, cost-effective, and reproducible modification of TAPP.