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Background <p>The transabdominal preperitoneal (TAPP) approach is a widely used minimally invasive technique for laparoscopic inguinal hernia repair. However, operative time and technical difficulty may vary depending on patient-related anatomical factors. This study evaluated the effect of the umbilicus–symphysis pubis (USP) distance on operative time and investigated whether this superficial anatomical measurement could guide patient selection.</p> Methods <p>In this retrospective study, data from 767 patients who underwent TAPP repair at Gazi University Hospital between January 2015 and June 2022 were reviewed. After applying the exclusion criteria, 341 male patients were included. Of these, 272 had unilateral and 69 had bilateral inguinal hernia. The distance between the umbilicus and symphysis pubis was measured preoperatively in all patients. The relationship between USP distance and operative time was analyzed using the Python-based Maximally Selected Rank Statistics (MaxStat) method, and optimal cut-off values were determined.</p> Results <p>The age range of the study group was 18.00–77.00 years, with a median age of 44.00 years. The USP distance ranged from 9.70 to 23.50&#xa0;cm in unilateral cases and from 11.10 to 22.30&#xa0;cm in bilateral cases. MaxStat analysis identified optimal cut-off values of 15&#xa0;cm for unilateral and 16&#xa0;cm for bilateral hernia cases. In unilateral cases, operative time was significantly longer in patients with a USP distance ≤ 15&#xa0;cm (<i>p</i> &lt; 0.001). Similarly, in bilateral cases, operative times were significantly longer when the USP distance was ≤ 16&#xa0;cm (<i>p</i> &lt; 0.001).</p> Conclusion <p>USP distance may serve as a simple and easily measurable anatomical parameter associated with surgical duration, particularly in unilateral TAPP repairs. As patients with a shorter USP distance were associated with longer operative times, this association warrants further prospective validation before USP distance can be considered a routine parameter in preoperative planning.</p>

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Association between umbilicus–symphysis pubis distance and operative time in transabdominal preperitoneal (TAPP) inguinal hernia repair

  • 期刊论文

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  • 发表日期：

    2026年4月29日

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  • Emre Gülçek,
  • Yunushan Furkan Aydoğdu,
  • Safa Özaydın,
  • Çağrı Büyükkasap

摘要

Background

The transabdominal preperitoneal (TAPP) approach is a widely used minimally invasive technique for laparoscopic inguinal hernia repair. However, operative time and technical difficulty may vary depending on patient-related anatomical factors. This study evaluated the effect of the umbilicus–symphysis pubis (USP) distance on operative time and investigated whether this superficial anatomical measurement could guide patient selection.

Methods

In this retrospective study, data from 767 patients who underwent TAPP repair at Gazi University Hospital between January 2015 and June 2022 were reviewed. After applying the exclusion criteria, 341 male patients were included. Of these, 272 had unilateral and 69 had bilateral inguinal hernia. The distance between the umbilicus and symphysis pubis was measured preoperatively in all patients. The relationship between USP distance and operative time was analyzed using the Python-based Maximally Selected Rank Statistics (MaxStat) method, and optimal cut-off values were determined.

Results

The age range of the study group was 18.00–77.00 years, with a median age of 44.00 years. The USP distance ranged from 9.70 to 23.50 cm in unilateral cases and from 11.10 to 22.30 cm in bilateral cases. MaxStat analysis identified optimal cut-off values of 15 cm for unilateral and 16 cm for bilateral hernia cases. In unilateral cases, operative time was significantly longer in patients with a USP distance ≤ 15 cm (p < 0.001). Similarly, in bilateral cases, operative times were significantly longer when the USP distance was ≤ 16 cm (p < 0.001).

Conclusion

USP distance may serve as a simple and easily measurable anatomical parameter associated with surgical duration, particularly in unilateral TAPP repairs. As patients with a shorter USP distance were associated with longer operative times, this association warrants further prospective validation before USP distance can be considered a routine parameter in preoperative planning.