Laparoscopic Inguinal Hernia Repair—TAPP versus TEP: Results of 301 Consecutive Patients

Abstract

Introduction: Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernia repair are the two most commonly used techniques in laparoscopic inguinal hernia repair, and the results of comparative studies are conflicting. The objective of this study is to compare the two methods in unilateral inguinal hernia repair. Materials and Methods: The data of consecutive patients who underwent TEP and TAPP due to unilateral inguinal hernia between December 7, 2017, and March 15, 2020, were analyzed retrospectively. The primary outcome was to compare the clinical outcomes of the two techniques in terms of complications, conversion, pain, and operative time. The secondary outcome was recurrence rates. Results: A total of 301 (TEP n=234, TAPP n=67) patients were included in the study. The mean age was 43 years, and the follow-up period was two years. The groups were similar in terms of demographic characteristics and hernia type. The mean operative time was longer in the TAPP group than in the TEP group (67 min and 58 min, p=0.007). The recurrence rate was 4.3% in the TEP group and 5.9% in the TAPP group (p>0.05). The conversion rate was 6% in both groups. In total, 19 (6.3%) patients had intraoperative complications (TEP n=16, TAPP n=3), and 23 (7.6%) patients had postoperative complications (TEP n=16, TAPP n=7). Both intraoperative and postoperative complication rates were similar between the groups (p=0.31 and p=0.051, respectively). The early postoperative pain was less in the TEP group (p=0.004). Conclusion: Less early postoperative pain and shorter operative time were detected in patients who underwent TEP.

Laparoscopic transabdominal preperitoneal and totally extraperitoneal in inguinal hernia surgery: comparison of intraoperative and postoperative early complications of two techniques

“…In our study, four irreducible cases were operated with TAPP and one case with TEP. In a single-center study of 275 patients who underwent TEP and TAPP, irreducible cases were reported at 2.5% and 0.6% in TAPP and TEP, respectively [ 16 ].…”

“…However, there was no recurrence detected in patients with TAPP. In one study, the researchers reported that some recurrence cases were related to the size of the mesh and that recurrence was more commonly seen in cases in which the mesh was small (6 × 9 cm) [ 16 ]. In our patients, although mesh size differed according to the hernia type and defect size, the smallest mesh size was 12 × 13 cm.…”

Comparative Review of Outcomes between Enhanced View Totally Extraperitoneal Technique with Inherently Divided Douglas’ Line and Totally Extraperitoneal Technique for Repairing Inguinal Hernia

“…Peritoneal tears were observed in 7.9% in TEP group (9) . In comparison with three studies, the conversion rate of TEP to open or TAPP was 5.3% (27) . Peritoneal tears were detected in 47% of patients using the TEP method in 123 cases; 13% of these tears were substantial, therefore conversion was preferable (7) .…”

Current status and progress of laparoscopic inguinal hernia repair: A review

“…Nevertheless, there was no significant difference in the length of postoperative hospital stay, complication rate, or recurrence rate between patients treated with the 2 procedures. [30,31]…”

“…Nevertheless, there was no significant difference in the length of postoperative hospital stay, complication rate, or recurrence rate between patients treated with the 2 procedures. [30,31] Some scholars have proposed the concept of the inverted Y and 5 triangles regarding the anatomy in the inguinal region. [32] According to this new anatomical concept, the inguinal region is subdivided into 3 zones: zone 1, corresponding to the lateral region of the deep inguinal ring and spermatic cord blood vessels; zone 2, including the inferior abdominal blood vessel and the medial side of the vas deferens and corresponding to direct hernias; and zone 3, including the inferior abdominal wall vessels, the deep inguinal ring, the spermatic cord unit and the external iliac vessels, which are surgical areas that need more attention (Fig.…”