Resection versus Preservation of Spermatic Cord Lipoma Present with Inguinal Hernia during Laparoscopic TAPP Repair; a Comparative Study

Background: Spermatic cord lipoma (SCL) is a common incidental finding during inguinal hernia repair. The optimal management, excision versus preservation, remains debated, with proponents of each approach citing distinct benefits regarding postoperative complications and recurrence rates. Objective: This study aimed to compare the postoperative outcomes of spermatic cord lipoma excision versus lipoma preservation in patients undergoing laparoscopic TAPP inguinal hernia repair. Patients and methods: A prospective comparative study of 100 male patients divided into two groups (50 per group) who underwent laparoscopic TAPP inguinal hernia repair. Group A where patients underwent concurrent spermatic cord lipoma excision and group B where patients had their lipoma preserved. Demographic variables, hernia type, and postoperative outcomes including scrotal swelling, pain, hematoma, false recurrence, true recurrence, and reoperation were recorded. Results: The mean age was 41.82 ± 11.27 years in group A and 47.98 ± 14.28 years in group B (p = 0.019). Indirect inguinal hernia was the most prevalent type in both groups. Group A exhibited a significantly higher incidence of scrotal swelling (12% vs. 2%, p = 0.050) and lower postoperative pain (4% vs. 16%, p = 0.046). Elevated BMI was significantly associated with scrotal swelling, hematoma, and false recurrence in group A. In group B, false recurrence was significantly associated with direct and bilateral hernia types (p = 0.018). True recurrence and reoperation rates were low and comparable between groups (2% each overall). BMI correlated positively with age in group B (r = 0.363, p = 0.010). Conclusion: Spermatic cord lipoma excision was associated with higher rates of scrotal swelling but lower postoperative pain compared to preservation. Both approaches demonstrated low recurrence and reoperation rates. Individualized decision-making based on hernia type, patient BMI, and clinical context is recommended. Further prospective randomized trials are warranted. ？