Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials

Abstract

Purpose To examine the updated evidence on safety, effectiveness, and outcomes of the totally extraperitoneal (TEP) versus the laparoscopic transabdominal preperitoneal (TAPP) repair and to explore the timely tendency variations favoring one treatment over another. Methods Systematic review and trial sequential analysis (TSA) of randomized controlled trials (RCTs). MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were consulted. Risk Ratio (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were used as pooled effect size measures. Results Fifteen RCTs were included (1359 patients). Of these, 702 (51.6%) underwent TAPP and 657 (48.4%) TEP repair. The age of the patients ranged from 18 to 92 years and 87.9% were males. The estimated pooled RR for hernia recurrence (RR = 0.83; 95% CI 0.35–1.96) and chronic pain (RR = 1.51; 95% CI 0.54–4.22) were similar for TEP vs. TAPP. The TSA shows a cumulative z-curve without crossing the monitoring boundaries line (Z = 1.96), thus supporting true negative results while the information size was calculated as adequate for both outcomes. No significant differences were found in term of early postoperative pain, operative time, wound-related complications, hospital length of stay, return to work/daily activities, and costs. Conclusions TEP and TAPP repair seems comparable in terms of postoperative hernia recurrence and chronic pain. The cumulative evidence and information size are sufficient to provide a conclusive evidence on recurrence and chronic pain. Similar trials or meta-analyses seem unlikely to show diverse results and should be discouraged.

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

“…First, most of our patients were from far away and remote places so they were not discharged at the earliest in both the groups. Our results were consistent with three other studies [ 11 , 14 - 16 ]. Two studies have reported a longer duration of hospital stay in the TAPP group compared to the TEP group.…”

“…The resumption of routine activity was statistically not significant in the two groups (p-value=0.732). Three studies have shown similar outcomes [ 11 , 14 - 16 , 19 , 22 , 23 ]. All the patients did well at seven days and the three-month follow-up.…”

“…In this study, one patient had intraoperative complications in the TEP group and one patient had postoperative complications in each group. However, the difference was statistically insignificant [ 14 , 16 , 19 , 20 ]. Although seroma formation was found twice in the TEP group, it was diagnosed clinically and managed conservatively.…”

İnguinal Hernilerde Balonsuz ve Mesh Sabitleyicisiz Laparoskopik Total Ekstraperitoneal Onarımın Cerrahi Deneyim ile Korelasyonu

“…Günümüzde Laparoskopik cerrahi yaklaşımlar, daha az postoperatif ağrı oluşturmaları ve normal aktivitelere hızlı bir dönüş sağlamaları gibi avantajları nedeniyle giderek daha yaygın hale gelmektedir 5 . İntraoperatif komplikasyonların yüksek olması ve cerrahi zorluk nedeniyle öğrenme eğrisinin gerekmesi laparoskopik onarımın negatif yönlerini oluşturmaktadır 6 9 .…”

Laparoscopic totally extraperitoneal hernia repair performed by surgical trainees: overcoming the learning curve

“…5 The two standard techniques for laparoscopic IH repair (LIHR), the totally extraperitoneal (TEP) repair and the transabdominal preperitoneal (TAPP) repair, have been repeatedly shown to not differ significantly in regards to both shortand long-term outcomes, with the choice of approach largely a matter of individual surgeon preference and training. [6][7][8] The international guidelines published by the HerniaSurge Group recommend a laparoscopic approach for primary unilateral IH due to a reduction in both postoperative and chronic groin pain, as well as the potential to miss a femoral hernia in female patients. 9 It is also the approach of choice for bilateral IH and recurrent IH following a failed anterior repair.…”