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

## TL;DR

This study shows that performing two surgeries at once—inguinal hernia repair and gallbladder removal—is safe, faster, and cheaper than doing them separately.

## Contribution

The study introduces a new surgical approach combining TEP hernia repair and laparoscopic cholecystectomy, demonstrating its safety and cost-effectiveness.

## Key findings

- No infections occurred in either group, confirming the safety of simultaneous surgery.
- Combined surgery reduced total operation time and hospital stay by over 30%.
- Patients returned to work faster and saved about 51% in costs for unilateral hernias.

## Abstract

Background and Objectives: 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). Materials and Methods: 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 (n = 16), undergoing synchronous TEP and LC; and the Staged Group (n = 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). Results: 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; p = 0.003) and yielded a shorter hospitalization period (1.44 ± 0.51 vs. 2.31 ± 0.85 days; p = 0.002). Workforce reintegration was markedly accelerated in the simultaneous group (9.43 ± 3.36 vs. 24.69 ± 12.35 days; p < 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.