Transabdominal Preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair – A systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundTransabdominal Preperitoneal (TAPP) and Lichtenstein operation are established methods for inguinal hernia repair in clinical practice. Meta-analyses of randomized controlled studies, comparing those two methods for repair of primary inguinal hernia, are still missing. In this study, a systematic review and meta-analysis of published randomized controlled trials was performed to compare early and long term outcomes of the two methods.MethodsA literature search was carried out to identify randomized controlled trials, which compared TAPP and Lichtenstein repair for primary inguinal hernia. Outcome measures included duration of operation, length of hospital stay, acute postoperative and chronic pain, time to return to work, hematoma, wound infection, neuralgia, numbness, scrotal swelling, seroma and hernia recurrence. A quantitative meta-analysis was performed, using Odds Ratios (OR) or Standardized Mean Difference (SMD), and Confidence Interval (CI).ResultsEight controlled randomized studies were identified suitable for the analysis. The mean duration of the operation was shorter in Lichtenstein repair (SMD = 6.79 min, 95% CI, −0.68 – 14.25), without significant difference. Comparing both techniques, patients of the laparoscopic group showed postoperatively significantly less chronic inguinal pain (OR = 0.42; 95% CI, 0.23–0.78). Analyses of the remaining outcome measures did not show any significant differences between the two techniques.ConclusionThe results of this analysis indicate that complication rate and outcome of both procedures are comparable. TAPP operation demonstrated only one advantage over Lichtenstein operation with significantly less chronic inguinal pain postoperatively.

Current Concepts of Inguinal Hernia Repair

“…No difference in the recurrence rates was found; however, a lower incidence of wound infection, an earlier return to normal activities or work, and a lesser incidence of chronic pain syndrome could be detected [17]. Two meta-analyses comparing only TEP and one comparing only TAPP with the Lichtenstein technique could not deliver sufficient evidence to determine the greater effectiveness of one over the other technique [19][20][21].…”

Laparoscopic totally extra‐peritoneal groin hernia repair with self‐gripping polyester mesh: a series of 780 repairs

“…Inguinal hernias account for approximately 97% of all groin hernia repairs with males representing 90% of these repairs . Inguinal hernias have been repaired through a variety of approaches with growing evidence comparing open, laparoscopic transabdominal preperitoneal, and totally extra‐peritoneal (TEP) approaches . The introduction of robotic surgery provides another emerging minimally invasive approach .…”

Efficiency of the pre-peritoneal transabdominal videolaparoscopic hernioplasty and Lichtenstein-type open hernioplasty at the National Hospital of Itauguá

“…Scheuermann y colaboradores en el 2017, en Alemania, realizaron una revisión sistemática y meta análisis aleatorizado en el que se constata que la estadía hospitalaria va de 1 a 5 días como máximo, coincidiendo con nuestros resultados con el mayor porcentaje de estadía a los 2 días (8) .…”