DOI: http://dx.doi.org/10.18203/2349-2902.isj20171017

A comparative study of totally extraperitoneal versus transabdominal preperitoneal repair of inguinal hernias

Sudarshan P. B., Sundaravadanan B. S., Prabu Shankar S.

Abstract


Background: The two common procedures which are nowadays commonly performed for laparoscopic repair of inguinal hernia are transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) mesh repair. This retrospective study was aimed to compare these two, TAPP and TEP laparoscopic approaches for inguinal hernia repair in terms of various outcomes.

Methods: In this retrospective study, we included 50 cases of inguinal hernia who underwent laparoscopic approach of inguinal hernia repair at Saveetha medical college and hospital between 2014 and 2016 for a duration of 3 years. Various parameters including the age, sex of patient, type of hernia, preoperative and post-operative complications, duration of hospital stay was analysed.

Results: Of the 50 patients who underwent laparoscopic repair, 26 patients underwent TEP and 24 patients under went TAPP procedure. 31 cases were indirect inguinal hernias and 30 cases were direct inguinal hernias, totalling 61 hernia repairs, as 11 patients had bilateral hernia. One female inguinal hernia and 4 cases of recurrent hernia were operated by TAPP method. Postoperative complications like seroma formation; subcutaneous emphysema was seen in TEP group. Two cases of TEP were converted to TAPP and open lichenstein procedure. Postoperative pain was less in both the group. Patients who underwent TEP procedure spent less time in the hospital compared to those who underwent TAPP procedure.

Conclusions: There is no major difference in the outcome after TEP and TAPP surgeries except for some minor complications and the results are comparable in both techniques TAPP and TEP. Both the procedures can be practiced according to surgeon’s familiarity of the procedure.


Keywords


Hernioplasty, Inguinal hernia repair, Laparoscopic hernia repair, TAPP, TEP

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References


Usher FC. The herniologist of the twentieth century. Hernia. 1999;3:57-61.

Bax T, Sheppard BC, Crass RA. Surgical options in the management of groin hernias. Am Fam Physician. 1999;59:893-906.

Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM. Open mesh versus non-mesh for repair of femoral and inguinal hernia Cochrane Database Syst Rev. 2002;(4):CD002197.

Sains PS, Tilney HS, Purkayastha S, Darzi AW, Athanasiou T, Tekkis PP, et al. Outcomes following laparoscopic versus open repair of incisional hernia. World J Surg. 2006;30(11):2056-64.

Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350(18):1819-27.

Arregui ME, Davis CJ, Yucel O, Nagan RF. Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach: a preliminary report. Surg Laparosc Endosc. 1992;2(1):53-8.

Arregui ME, Navarrete J, Davis CJ, Castro D, Nagan RF. Laparoscopic inguinal herniorrhaphy. Techniques and controversies. Surg Clin North Am. 1993;73:513-27.

McKernan JB, Laws HL. Laparoscopic repair of inguinal hernia using totally extraperitoneal prosthetic approach. Surg Endosc. 1993;7(1):26-8.

Gong K, Zhang N, Lu Y, Zhu B, Zhang Z, Du D, et al. Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: A prospective randomized controlled trial. Surg Endosc. 2011;25:234-9.

Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343-403.

Akin ML, Karakaya M, Batkin A, Nogay A. Prevalence of inguinal hernia in otherwise healthy males of 20 to 22 years of age. J R Army Med Corps. 1997;143(2):101-2.

Tackett LD, Breuer CK, Luks FI, Caldamone AA, Breuer JG, DeLuca FG, et al. Incidence of contra lateral inguinal hernia: a prospective analysis. J Pediatr Surg. 1999;34(5):684-7.

Griffin KJ, Harris S, Tang TY, Skelton N, Reed JB, Harris AM. Harris Incidence ofcontra lateral occult inguinal hernia found at the time of laparoscopic transabdominal preperitoneal (TAPP) repair. Hernia. 2010;14(4):345-9.

O'Rourke A, Zell JA, Varkey-Zell TT, Barone JL, Bayona BM. Laparoscopic diagnosis and repair of asymptomatic bilateral inguinal hernias. Am J Surg. 2002;183(1):15-9.

Cohen RV, Alvarez G, Roll S, Garcia ME, Kawahara N,Schiavon CA, et al. Transabdominal or totally extraperitoneal laparoscopic hernia repair? Surg Laparosc Endosc. 1998;8(4):264-8.

Hahn-Pedersen J, Lund L, Højhus JH, Bojsen-Møller F. Evaluation of direct and indirect inguinal hernia by computed tomography. Br J Surg 1994;81:569-72.

Lau H, Lee F. Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc. 2003;17(11):1773-7.

Gong K, Zhang N, Lu Y, Zhu B, Zhang Z, Du D, et al. Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: A prospective randomized controlled trial. Surg Endosc. 2011;25:234-9.

Lepere M, Benchetrit S, Debaert M, Detruit B, Dufilho A, Gaujoux D, et al. A multicentric comparison of transabdominal versus totally extraperitoneal laparoscopic hernia repair using PARIETEX meshes. JSLS. 2000;4:147-53.

Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc. 2012;26:3355-66.

Gass M, Banz VM, Rosella L, Adamina M, Candinas D, Güller U. TAPP or TEP? Population-based analysis of prospective data on 4,552 patients undergoing endoscopic inguinal hernia repair. World J Surg. 2012;36:2782-6.