Safety, clinical outcomes, and cost-effectiveness of simultaneous laparoscopic cholecystectomy and TEP inguinal hernia repair: A retrospective cohort study

INTRODUCTION: The simultaneous performance of laparoscopic cholecystectomy (LC) and totally extraperitoneal (TEP) inguinal hernia repair remains controversial due to concerns about mesh infection when combining a clean-contaminated procedure with prosthetic mesh implantation. This study aimed to evaluate the safety, clinical outcomes, and cost-effectiveness of this combined approach.
METHODS: We retrospectively analyzed 37 consecutive patients who underwent simultaneous LC and TEP inguinal hernia repair between January 2019 and January 2024. TEP was performed first in all cases, with the umbilical port used for both procedures. Postoperative complications were graded according to the Clavien-Dindo classification. Patient satisfaction was assessed via a questionnaire. Costs were calculated using standardized governmental reimbursement rates.
RESULTS: The median operative time was 85 minutes (IQR: 78-89). No conversions to open surgery or TAPP were recorded. Intraoperative complications occurred in 3 patients (8.1%). Postoperative complications were observed in 6 patients (16.2%), including seroma (n=3), wound infection at the epigastric port site (n=2), and urinary retention (n=1). No mesh infections were recorded. Most patients (97.3%) were discharged on postoperative day 1. Over a median follow-up of 32 months, one recurrence (2.7%) was observed. Patient satisfaction was high, with 91.9% willing to undergo the combined procedure again. The simultaneous approach yielded a 7.7% cost reduction for unilateral cases compared to staged surgery.
DISCUSSION AND CONCLUSION: Simultaneous LC and TEP inguinal hernia repair is a safe and feasible procedure with no in-crease in mesh-related complications. The hernia-first approach and anatomical separation of operative fields support the safety of this combined strategy.

Keywords: Laparoscopic cholecystectomy, totally extraperitoneal repair, inguinal hernia, mesh infection, simultaneous surgery