Implementation of Transabdominal Preperitoneal Repair in a Super-aged Region: A Propensity Score-Matched Analysis of Inguinal Hernia Repair in Patients Aged ≥75 Years.

Abstract

Purpose This study aimed to compare the laparoscopic transabdominal preperitoneal repair (TAPP) and open repair in older patients with inguinal hernia and determine whether the TAPP approach offers superior safety and effectiveness. Methods We retrospectively reviewed the medical records of patients aged ≥75 years who underwent primary unilateral inguinal hernia repair at Honjo Daiichi Hospital, Akita Prefecture, Japan, between October 2016 and December 2024. Bilateral, recurrent, and emergency cases were excluded. Propensity score matching with age, sex, body mass index, American Society of Anesthesiologists physical status, and antithrombotic use yielded 27 patients each for the TAPP and open groups. Endpoints were operative time, blood loss, hospital stay, analgesic use, complications (Clavien-Dindo grade ≥II), and recurrence. Results The TAPP group had a significantly longer operative time (102.6 ± 28.6 vs. 86.3 ± 19.2 min, p = 0.018), but lower blood loss (0 vs. 2.5 g, p < 0.001) and a shorter hospital stay (4.37 ± 2.06 vs. 7.63 ± 2.72 days, p < 0.001) than the open group. Analgesic use (p = 0.297) and complication rates (p = 0.236) did not differ, and no recurrences were observed. Conclusions In our cohort of patients aged ≥75 years, the TAPP approach was associated with reduced blood loss and shorter hospital stays, with comparable safety to that of the open repair. In a super-aged region such as the Akita Prefecture, these findings support the TAPP approach as a safe and effective standard option for older adults.