Simultaneous TEP Inguinal Hernia Repair and Laparoscopic Cholecystectomy: A Retrospective Analysis of Safety, Cost-Effectiveness, and Outcomes.

Abstract

<i>Background and Objectives</i>: The concurrent management of cholelithiasis and inguinal hernia remains a subject of surgical debate, primarily due to concerns regarding prosthetic mesh infection in a clean-contaminated field. This study evaluates the safety, cost-effectiveness, and functional outcomes of simultaneous totally extraperitoneal (TEP) repair and laparoscopic cholecystectomy (LC). <i>Materials and Methods:</i> A retrospective analysis was conducted on patients treated between 2015 and 2025 using a prospectively maintained institutional registry. The cohort was stratified into two arms: the Simultaneous Group (<i>n</i> = 16), undergoing synchronous TEP and LC; and the Staged Group (<i>n</i> = 13), managed via separate sessions. A strict "hernia-first" operative sequence was enforced to maintain sterility. Key endpoints included perioperative morbidity, long-term recurrence (mean follow-up: 53.9 months), economic burden, and quality of life (EuraHS-QoL). <i>Results:</i> No surgical site or prosthetic infections were documented in either cohort. The Simultaneous arm demonstrated a significantly reduced total operative duration compared to the cumulative time of the Staged approach (164.6 ± 44.9 vs. 226.2 ± 57.4 min; <i>p</i> = 0.003) and yielded a shorter hospitalization period (1.44 ± 0.51 vs. 2.31 ± 0.85 days; <i>p</i> = 0.002). Workforce reintegration was markedly accelerated in the simultaneous group (9.43 ± 3.36 vs. 24.69 ± 12.35 days; <i>p</i> < 0.001), translating to a total cost reduction of approximately 51% for unilateral cases. Conclusions: Concomitant TEP and LC represents a clinically viable and financially prudent strategy that does not compromise patient safety or prosthetic durability. Adherence to a strict "hernia-first" surgical sequence appears critical to preventing infectious morbidity. Given the superior resource utilization, this dual approach merits consideration as a primary therapeutic algorithm.