Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP)

Abstract

Background: The guidelines recommend laparoscopic repair for bilateral inguinal hernia. However, few studies compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernia. This study aimed to compare the outcomes of TEP and TAPP in bilateral inguinal hernia. Methods: We conducted a retrospective cohort study of patients operated on for bilateral inguinal hernia by TEP and TAPP repair from 2016 to 2020. Intraoperative complications, operative time, acute postoperative pain, hospital stay, postoperative complications, chronic inguinal pain, and recurrence were compared. Results: A total of 155 patients were included in the study. TEP was performed in 71 patients (46%) and TAPP in 84 patients (54%). The mean operative time was longer in the TAPP group than in the TEP group (107 min vs. 82 min, p<0.001). The conversion rate to open surgery was higher in the TEP group than in the TAPP group (8.5% vs. 0%, p=0.008). The mean hospital stay was longer in the TAPP group than in the TEP group (p<0.001). We did not observe significant differences in the proportion of postoperative complications(p=0.672), postoperative pain at 24 hours (p=0.851), chronic groin pain (p=0.593), and recurrence (p=0.471). We did not observe an association between the choice of surgical technique (TEP vs. TAPP) with postoperative complications, chronic inguinal pain, or hernia recurrence; when performing a multivariable analysis adjusted for the male sex, age ≥65 years, BMI ≥30, ASA II-IV, recurrent hernia repair, and hernia size >3cm. Conclusions: We did not find significant differences in postoperative complications, acute postoperative pain, chronic inguinal pain, and recurrence. Operative time and hospital stay were longer in TAPP, while TEP conversion to open surgery was higher.