TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia

Abstract

IntroductionMore than 20 years since the introduction of TAPP and TEP into clinical routine, there is a lack of clarity due to conflicting comparative data. Therefore, more results from registries are needed.Patients and methodsA total of 17,587 patients were enrolled prospectively between September 1, 2009, and April 15, 2013, in the Herniamed registry. Of these patients, 10,887 (61.9 %) had a TAPP and 6700 (38.1 %) a TEP repair. The dependent variables were intra- and postoperative complication rates, number of reoperations as well as absolute and relative frequencies. The results of unadjusted analyses were verified via multivariable analyses.ResultsMultivariable analysis verified the results of unadjusted analysis, indicating that the surgical technique did not have any significant impact, also while taking account of other factors, on occurrence of intraoperative [p = 0.1648; OR = 1.214 (0.923; 1.596)] and general postoperative complications [p = 0.0738; OR = 1.315 (0.974; 1.775)]. Postoperative surgical complications [OR = 2.323 (1.882; 2.866); p < 0.0001] were noted more often after TAPP. Furthermore, the hernia defect size [p < 0.0001; I vs III: OR = 0.439 (0.313; 0.615), II vs III: OR = 0.712 (0.582; 0.872)] or scrotal [p < 0.0001; OR = 2.170 (1.501; 3.137)] hernia and age [p = 0.0002; 10-year OR = 1.135 (1.062; 1.213)] had a significant impact on the occurrence of postoperative complications. Complications were observed more commonly for larger hernia defects and a scrotal hernia. However, the difference in the postoperative complication rate between TEP and TAPP did not result in any difference in the reoperation rate (TEP 0.82 % vs TAPP 0.90 %; p = 0.6165).ConclusionThe intraoperative and general postoperative complication rates as well as the reoperation rate for complications show no significant difference between TEP and TAPP. The higher postoperative complication rate for TAPP, which could be managed conservatively, is partly explained by larger defect sizes, more scrotal hernias and older age.

Prospective comparison of post-operative quality of life (QOL) after laparoscopic total extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) repair of indirect inguinal hernia

“…The results have been largely non-consistent, with no significant differences between TEP and TAPP. 7,[10][11][12][13] Few studies indicate TEP repair superior to TAPP in terms of postoperative complications, however, learning curve is steeper for TEP, making it a less preferred option as compared to TAPP. [14][15][16] As the era of minimally invasive surgery is advancing, the impact of these techniques on patient's quality of life is necessary to evaluate.…”

Die evidenzbasierte TEP-Technik

“…Obwohl es sich bei der TEP um eine komplexere Operationstechnik als die offene Leistenhernienchirurgie handelt und die Lernkurve länger ist als bei der TAPP, können bei Umsetzung der oben dargestellten standardisierten Technik mit der TEP bessere Ergebnisse als mit der Lichtenstein-Operation erzielt werden [7]. Auch mit der TAPP vergleichbare Ergebnisse können mit der TEP erreicht werden [4]. Somit ist die evidenzbasierte Durchführung der TEP nach den Guidelines der internationalen Herniengesellschaften die Voraussetzung für gute Ergebnisse mit der TEPTechnik.…”

Comparison of Lichtenstein, Laparoscopic Transabdominal Preperitoneal, and Laparoscopic Totally Extraperitoneal Groin Hernia Repair and our experience with 104 Patients

“…'nın çalışmasında LAO'da ameliyat süresi 45±8 dakika, TAPP'da 55±12 dakika, TEP'de ise 56±9 dakika olarak bulunmuştur (10). Köckerling'in çalışmasında ise TAPP'ın ameliyat süresinin TEP'den anlamlı olarak uzun olduğu saptanmıştır (11). Ameliyat süresinde TAPP'da peritoneal kapamanın TEP'den uzun olmasındaki en büyük etken diseksiyon öncesi peritonu açma ve kapamada geçen süredir.…”