Critical evaluation of an innovative mesh for bilateral transabdominal
preperitoneal (TAPP) repair of inguinal hernias
· I. Fischer
· R. Kaltenböck
· M. Mitteregger
· G. Seitinger
· A. Szyszkowitz
Received: 4 February 2018 / Accepted: 31 May 2018
© Springer-Verlag France SAS, part of Springer Nature 2018
Purpose Transabdominal preperitoneal hernia mesh plasty (TAPP) oﬀers signiﬁcant beneﬁts to patients undergoing bilateral
inguinal hernia repair. We evaluated a novel pre-shaped, large-pored, titanium-coated, lightweight polypropylene mesh for
bilateral placement as an alternative to two separate meshes.
Methods Thirty-six patients underwent elective surgical repair of bilateral inguinal hernias with the new mesh at three
departments of surgery in Linz and Graz, Austria, between May 1, 2015 and June 30, 2017.
Results All operations were completed without intraoperative complications or conversion to open procedures. The mean
operation time was 74 min. There were no postoperative procedure-related complications with the exception of one hema-
toseroma of the spermatic cord. Two symptomatic medial recurrences (2/36 patients = 5.6%, 2/72 hernia repairs = 2.8%,
respectively) after supravesical and medial hernia repair with the bilateral mesh were seen at structured follow-up examina-
tions 6 and 12 months postoperatively.
Conclusion Treatment of bilateral inguinal hernias with the newly designed bilateral mesh for TAPP theoretically brings
beneﬁts in terms of resistance to forces acting on the mesh. The larger area may decrease the risk for mesh bulging and
recurrence, and one large mesh might provide more stable support than two separate meshes overlapping at the midline.
The results of our study do not conﬁrm these theoretical beneﬁts regarding a high recurrence rate (2.8%) after treatment of
medial hernia defects. We recommend re-designing the mesh with only a small central slit, which would provide a broader
mesh bridge with suﬃcient overlap for all types of inguinal and femoral hernias, including medial and supravesical defects.
After the mesh has been re-designed, a new study should evaluate its real beneﬁts before it is marketed.
Keywords Transabdominal preperitoneal patch plasty · TAPP · Groin hernia · Inguinal hernia
Inguinal hernia repair, with an incidence of some 5–7%, is
the most common surgical procedure worldwide [1, 2]. For
this generally elective surgery, laparoscopic approaches and
tension-free mesh repairs have become an attractive alterna-
tive to open surgery . The simultaneous repair of bilateral
hernias is safe, with comparable pain and length of con-
valescence as for unilateral operations .Transabdominal
preperitoneal hernia mesh plasty (TAPP) oﬀers a signiﬁcant
beneﬁt for female patients, because reoperation rates after
anterior hernia repairs in women are higher than with men.
With TAPP, the whole myopectineal oriﬁce of Frucheaud 
can be overlapped. It also oﬀers beneﬁts to patients undergo-
ing bilateral or recurrent inguinal hernia repair after a previ-
ous anterior approach . The open posterior preperitoneal
* G. Köhler
Department of General and Visceral Surgery, Congregation
Hospital (Sisters of Charity), 4010 Linz, Austria
Department of Surgery, Paracelsus Medical University,
Academic Teaching Hospital, Medical University of Vienna,
Academic Teaching Hospital, Medical University of Graz,
Academic Teaching Hospital, Medical University
of Innsbruck, Innsbruck, Austria
Department of Surgery, St John of God Hospital, Graz,