Cao CP, Xiong H, Zhu ZH, Zhang JP. Clinical prediction model for inguinal hernia recurrence risk after transabdominal preperitoneal hernia repair surgery in elderly patients. World J Gastrointest Surg 2026; 18(10): 121585 [DOI: 10.4240/wjgs.121585]
Corresponding Author of This Article
Jian-Ping Zhang, Research Fellow, Department of General Surgery, Affiliated Hospital of Jiujiang University, No. 57 Xunyang East Road, Jiujiang 332000, Jiangxi Province, China. jianpingzhang6474@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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Cao CP, Xiong H, Zhu ZH, Zhang JP. Clinical prediction model for inguinal hernia recurrence risk after transabdominal preperitoneal hernia repair surgery in elderly patients. World J Gastrointest Surg 2026; 18(10): 121585 [DOI: 10.4240/wjgs.121585]
Chuan-Pei Cao, Huan Xiong, Zhi-Hua Zhu, Jian-Ping Zhang, Department of General Surgery, Affiliated Hospital of Jiujiang University, Jiujiang 332000, Jiangxi Province, China
Author contributions: Cao CP responsible for the entire research process, including study design, data collection, statistical analysis, and manuscript drafting and revision; Xiong H and Zhu ZH participated in data collection, literature review, and manuscript proofreading; Zhang JP provided overall guidance for the research, conducted critical review and final revision of the manuscript. All the authors have read and approved the final version of the manuscript.
AI contribution statement: The authors declare that no AI tools were used in the development or writing of this manuscript and take full responsibility for its integrity, accuracy, and originality.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Affiliated Hospital of Jiujiang University (Approval No. 2026-083).
Informed consent statement: All individuals who participated in this study provided written informed consent prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Corresponding author: Jian-Ping Zhang, Research Fellow, Department of General Surgery, Affiliated Hospital of Jiujiang University, No. 57 Xunyang East Road, Jiujiang 332000, Jiangxi Province, China. jianpingzhang6474@163.com
Received: April 30, 2026 Revised: June 3, 2026 Accepted: July 1, 2026 Published online: October 27, 2026 Processing time: 170 Days and 19.2 Hours
Abstract
BACKGROUND
Inguinal hernia is a common surgical condition in elderly individuals. Postoperative recurrence after laparoscopic transabdominal preperitoneal hernia repair (TAPP) remains an important clinical challenge. However, reliable predictive tools to assess the risk of recurrence are limited.
AIM
To establish and validate a clinical prediction model for the risk of recurrence after TAPP in elderly patients with inguinal hernia.
METHODS
Data from 300 elderly patients with inguinal hernia admitted to the Affiliated Hospital of Jiujiang University between January 2023 and January 2025 were retrospectively collected. All patients underwent TAPP in the hospital and were followed up for 24-72 months postoperatively. Inguinal hernia recurrence was observed; patients were subsequently divided into recurrence and non-recurrence groups. Differences in the general data between the two groups were compared. Logistic regression was used to identify factors associated with postoperative recurrence, and these multivariate factors were incorporated into R software to establish a visualized nomogram model. The patients were randomly divided into training and validation sets at a ratio of 7:3. Receiver operating characteristic curve, clinical calibration curve, and decision curve analysis were used to evaluate the diagnostic efficacy and clinical net benefit of the prediction model.
RESULTS
Among the 300 patients, 40 (13.33%) developed postoperative recurrence. Multivariate logistic regression analysis identified male sex, higher preoperative body mass index, smoking history, chronic constipation, incarcerated hernia, and polypropylene mesh use as independent risk factors for recurrence (P < 0.05). The nomogram prediction model demonstrated a good predictive performance, with area under the curve values of 0.895 and 0.933 in the training and validation sets, respectively.
CONCLUSION
Male sex, high preoperative body mass index, smoking history, chronic constipation, incarcerated hernia, and intraoperative use of polypropylene mesh are the major risk factors for inguinal hernia recurrence after TAPP in elderly patients. The constructed recurrence risk prediction model demonstrates high clinical efficacy, practicability, and net benefit, providing a reference for clinicians to screen high-risk patients.
Core Tip: Postoperative recurrence after transabdominal preperitoneal hernia repair remains a major concern in elderly patients with inguinal hernia. This study identified six independent risk factors associated with recurrence and developed a nomogram prediction model with favorable discrimination and calibration performance. This model may facilitate individualized perioperative risk assessment and early intervention strategies in elderly patients undergoing transabdominal preperitoneal hernia repair.
