Occurrence and management of postoperative bleeding in laparoscopic inguinal hernia repair: a single-institution case series

Background: Laparoscopic inguinal hernia repair by trans-abdominal pre-peritoneal (TAPP) approach, has become an increasingly common surgical option for the treatment of this prevalent condition. However, despite its numerous advantages, including reduced post-operative pain and faster return to normal daily activities, the possibility of major bleeding must be considered a risk. Although is a rare complication, its incidence has been reported between 3–8%, and it can lead to significant morbidity. This study aimed to explore the occurrence and management of early postoperative hematoma defined as intra- or retroperitoneal bleeding at the surgical site (excluding bleeding from port site insertion) following TAPP hernia repair. Case Description: Between 2021 and 2023, 262 TAPP hernia repairs were performed at a single institution. Of these, three patients (1.1%) developed postoperative hematomas requiring additional interventions. Two male patients with bilateral hernias and one female patient with a unilateral femoral hernia were affected. All patients were under 75 years old, and one continued aspirin therapy. Postoperative management varied: one patient required angioembolization, another received conservative management, and the third underwent surgical revision for hematoma evacuation. The incidence of bleeding was documented using contrast-enhanced computed tomography scans, which confirmed venous bleeding in one case and unidentified sources of bleeding in the others. Conclusions: Despite its low incidence, postoperative hematoma remains a significant complication of TAPP hernia repair. The study’s findings suggest that careful surgical technique, such as reducing pneumoperitoneum to enhance vessel visualization and minimizing the risk of injury to small vessels like the “corona mortis”, can help reduce the likelihood of bleeding. Although TAPP is generally a safe and effective procedure with a low rate of major bleeding complications, awareness and prompt intervention are essential for managing rare but serious adverse events. Future studies with larger sample sizes are necessary to further assess these findings and refine procedural techniques.