Publication:

Modified “keyhole” technique for preservation of the uterine round ligament during transabdominal preperitoneal with groin hernias: a case series of 9 patients

The "keyhole" technique, utilized in laparoscopic transabdominal preperitoneal (TAPP) hernia repair, sacrifices the integrity of the mesh, which is critical for preventing hernia recurrence. We present a series of 9 female patients with inguinal hernias who underwent TAPP using a modified "keyhole" technique at our hospital between January 2022 and June 2025. The modified technique involved precise mesh positioning using a dual-mesh configuration, with the two mesh pieces straddling the round ligament from above and below, and the openings closed with sutures to restore mesh integrity. The mean operative time was 46.8±8.9 min, and the mean estimated blood loss was 7.7±2.8 ml. No postoperative complications were observed, and all patients reported satisfactory recovery. At a mean follow-up of 12 months, no recurrence, mesh infection, or chronic pain was documented. This modified "Keyhole" technique appears to be a feasible and effective approach for female patients with inguinal hernias, offering favorable short-term outcomes while preserving the round ligament and maintaining mesh integrity. Our series suggests that this technique may reduce the risk of recurrence associated with conventional Keyhole repair, though long-term follow-up in larger cohorts is warranted.