Feasibility and safety of totally extraperitoneal inguinal hernia repair in patients with previous lower abdominal surgery

INTRODUCTION: Previous lower abdominal surgery (PLAS) has traditionally been considered a relative contraindication to totally extraperitoneal (TEP) inguinal hernia repair due to concerns about adhesions, distorted anatomy and increased risk of complications or conversion rate. PATIENTS AND METHODS: A single-centre retrospective analysis of prospectively collected data was performed on 576 consecutive patients who underwent TEP repair for primary inguinal hernia between October 2021 and June 2025. Patients were divided into PLAS and No-PLAS groups. Demographic characteristics, operative details (operative time, conversion rate and intraoperative complications) and post-operative outcomes (seroma, haematoma and recurrence) were compared. RESULTS: The PLAS cohort (n = 43) included diverse previous operations (open appendectomy: 30.2%, prostatectomy: 27.9%, varicocelectomy: 18.6%, caesarean section: 14.0% and other surgeries: 9.3%). The groups were comparable in age, body mass index, smoking status, operative time (median 50 vs. 45 min, P = 0.95) and follow-up duration (37 vs. 35, P = 0.63). Patients with PLAS were less frequently male (81.4% vs. 95.8%, P = 0.03). Conversion rate was significantly higher in the PLAS group (7.0% vs. 0.8%, P < 0.01), as was post-operative haematoma (2.3% vs. 0%, P < 0.01). No significant differences were observed in seroma, drain usage or recurrence rates. CONCLUSION: TEP inguinal hernia repair is safe and feasible in patients with a history of varied lower abdominal surgery, offering short- and long-term outcomes comparable to those without prior surgery. Although the risk of conversion and minor haematoma is modestly higher (likely due to adhesion-related dissection challenges), these do not significantly affect overall results. Therefore, TEP should be reconsidered in patients with a history of PLAS in experienced hands.