Pain After Transabdominal Preperitoneal (TAPP) or Totally Extraperitoneal (TEP) Technique for Unilateral Inguinal Hernia: A Randomized Controlled Trial

Abstract

Introduction Laparoscopic inguinal hernia repair is the most commonly performed surgery in many hospitals. This study aimed to compare the outcome of the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques in unilateral, uncomplicated inguinal Hernia. Material and methods This prospective randomized study was conducted in a tertiary care hospital in North India from November 2018 to March 2020. Sixty-eight male patients of unilateral, uncomplicated inguinal hernia were enrolled for laparoscopic hernia repair. The first group of 34 patients underwent TAPP repair and the second group of 34 patients underwent TEP repair under general anesthesia (GA). Both groups were compared for intraoperative or postoperative complications, analgesic requirements, postoperative pain, length of hospital stay, resumption of routine activity, and patient satisfaction scores. Fisher's exact test or Chi-square test were used for nominal data and the median or interquartile range was used for ordinal data. Results The mean operative time for TAPP was more than that for the TEP group (101 vs 76, p<0.001). The TAPP group exhibited significantly less postoperative pain at six hours, 24 hours and seven days than TEP (p<0.001) and an insignificant difference at three months of the follow-up period (p=0.188). Additional analgesics requirement was less in the TAPP group, although the difference was not significant (p=0.099). Seroma formation was found in four patients (11.8%) in the TEP group and two patients (5.9%) in the TAPP group (p= 0.672). Length of postoperative hospital stay (p=0.907), resumption of routine activity (p=0.732), and patient satisfaction scores (p=0.492) during follow-up were similar in both groups and were also insignificant. Conclusion The TAPP technique is slightly better than TEP for inguinal hernia in terms of lesser postoperative pain with similar chances of complications and other outcomes.

Comparison of Extended Total Extraperitoneal (E-TEP) Repair and Trans-Abdominal Pre-Peritoneal (TAPP) Mesh Repair in Inguinal Hernia Repair

“…In the current study, the duration of operation was significantly less in the E-TEP group compared to the TAPP group (78.33±8.16 minutes vs 99.73±9.81 minutes, P=0.00). These findings resemble the results of the study conducted by Bansal et al and Rodha et al [12][13][14]. The shorter surgical time required for E-TEP repair compared to TAPP repair may be because most of the cases in these studies involved unilateral hernias, and the initial space in E-TEP was filled with either a native glove finger balloon or a balloon dissector before the lateral space was only dissected.…”

Postoperative outcomes using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty in inguinal hernia: A comparative analysis with 1‐year follow‐up

“…2,[15][16][17][18] As it was done in our study where, due to lack of resources and high costs, laparoscopic approaches were not performed and the Nyhus-type open technique was chosen as the first line approach, to completely reinforce the myopexy orifice and at the same time to be able to correct femoral hernias, with the benefit of being able to open the parietal peritoneum and evaluate the hernial content in cases of incarcerated and/or strangulated hernias and additionally it is the open procedure homologous to the laparoendoscopic repair of inguinal hernias, that is to say, the Nyhus technique allows placing the mesh in the same space in which the laparoscopic techniques TEP (totally extraperitoneal laparoscopy techniques) and TAPP (transabdominal preperitoneal laparoscopy techniques) are placed. 19,20 The most commonly used open surgical approach today is the Lichtenstein repair, because of its low recurrence rates, ease of performance, short learning curve, and the fact that it can be performed under local anesthesia. 17,21,22 The purpose of this procedure is to approach the inguinal canal through the anterior approach.…”

“…The selection of one or the other should take into account the surgeon's learning curve, costs, experience, surgical history, emergency intervention, resources in the hospital institution, recovery time, complications, patient comorbidities, and hernia characteristics, such as size, recurrence, presence of incarceration, and/or strangulation 2,15–18 . As it was done in our study where, due to lack of resources and high costs, laparoscopic approaches were not performed and the Nyhus‐type open technique was chosen as the first line approach, to completely reinforce the myopexy orifice and at the same time to be able to correct femoral hernias, with the benefit of being able to open the parietal peritoneum and evaluate the hernial content in cases of incarcerated and/or strangulated hernias and additionally it is the open procedure homologous to the laparoendoscopic repair of inguinal hernias, that is to say, the Nyhus technique allows placing the mesh in the same space in which the laparoscopic techniques TEP (totally extraperitoneal laparoscopy techniques) and TAPP (transabdominal preperitoneal laparoscopy techniques) are placed 19,20 …”

Perioperative outcomes using Lichtenstein-type open hernioplasty versus Nyhus-type preperitoneal hernioplasty in inguinal hernia: a comparative study with 1-year follow-up

“…The selection of one or the other should take into account the surgeon's learning curve, costs, experience, surgical history, emergency intervention, resources in the hospital institution, recovery time, complications, patient comorbidities and hernia characteristics such as size, recurrence, presence of incarceration and/or strangulation [2,13,14,15,16]. As it was done in our study where, due to lack of resources and high costs, laparoscopic approaches were not performed and the Nyhus-type open technique was chosen as the rst line approach, in order to completely reinforce the myopexy ori ce and at the same time to be able to correct femoral hernias, with the bene t of being able to open the parietal peritoneum and evaluate the hernial content in cases of incarcerated and/or strangulated hernias and additionally it is the open procedure homologous to the laparo-endoscopic repair of inguinal hernias, that is to say, the Nyhus technique allows placing the mesh in the same space in which the laparoscopic techniques TEP (totally extraperitoneal laparoscopy techniques) and TAPP (transabdominal preperitoneal laparoscopy techniques) are placed [17,18].…”