Recurrence after implementation of an updated intraoperative protocol for totally extraperitoneal (TEP) inguinal hernia repair in a high-volume clinic - a retrospective cohort study

The adjusted intraoperative protocol demonstrated a non-significant declining trend of reoperations for recurrence-like complaints. Lipoma reduction was already well-implemented. While mesh fixation increased, it had no significant effect on the recurrence rate, so careful selection of hernias requiring fixation warrants attention.