“Concealed to be Unconcealed”: The Overlooked Role of the TAPP Repair in Occult Inguinal Hernia

Introduction: Inguinal hernia is among the most common conditions in general surgical practice which respondswell to surgical repair.1 It’s bilateral presentation is reported in up to 16% of cases.2 Diagnosis typically relies onclinical examination and, in uncertain cases, soft tissue ultrasound. However, studies report that 10%–20% ofoccult hernias may be missed by ultrasonography and later identified incidentally during transabdominal preperitoneal(TAPP) repair.3Aim of study: This study investigates the incidence of occult (Concealed) inguinal hernias discoveredintraoperatively during TAPP repair.Patients and methods: Between March 2022 and January 2025, 100 patients with unilateral, symptomatic,uncomplicated inguinal hernia confirmed by ultrasound were enrolled. All underwent classic three-port laparoscopicTAPP repair on the affected side. The contralateral side was laparoscopically inspected without routine dissection.Incidental occult hernias were repaired during the same session if detected. Preoperative consent includeddiscussion of this possibility.Results: The study population consisted of 90 males and 10 females, aged 23 to 64 years (Mean age 38 ± 2years). The indirect-to-direct hernia ratio was 3:2 (60 vs. 40 cases), and the right-to-left side ratio was 1.9:1 (66vs. 34 cases). Occult hernias were identified in 16% of patients (16 cases): 10 on the left and 6 on the right. Ofthese, 12 were concealed indirect hernias and 4 were direct.Conclusion: Occult inguinal hernias missed by preoperative ultrasonography occur with notable frequency andcan be detected during TAPP repair. These findings suggest reconsideration of TAPP as the preferred approacheven in apparently unilateral hernias.