A comparative study between totally extraperitoneal and transabdominal preperitoneal laparoscopic inguinal hernia repair techniques

Samir Ushakant Rambhia, Rajan Modi


Background: Laparoscopic groin hernia repair can be done by trans-abdominal pre-peritoneal (TAPP) approach and also by total extra peritoneal (TEP) approach. The objective of this study was to compare the clinical effectiveness and relative efficiency of trans-abdominal pre-peritoneal (TAPP) versus totally extra peritoneal (TEP) techniques of laparoscopic inguinal hernia repair.

Methods: All the patients aged 18 years and above admitted in HBT Hospital undergoing laparoscopic inguinal hernia repair were included in this study from June 2014 to January 2016. Diagnosis was made based on history and clinical examination and ultrasound scan of the abdomen. Patients undergoing open hernia surgery and those having contra-indications to laparoscopic hernia repair were excluded from the study. The patients underwent laparoscopic TAPP or laparoscopic TEP repair of hernia based on surgeon’s preference.

Results: Total 56 patients were included in the study. It was a non-randomized study, where patients were allocated in TAPP and TEP group based on surgeon’s preference. Hence, 29 patients were included in TAPP group while 27 patients were allocated to TEP group. Post-operatively all patients were evaluated for pain at 6 hours, 12 hours, 24 hours, 1week, 6 months and 1 year. They were also evaluated for length of hospital stay and any operative site complication like hematoma/seroma, wound/mesh infection, recurrence, port site hernia, persisting numbness. 2 patients in TAPP group and 3 in TEP group were lost to follow up at the end of 1 month. Further 4 patients in TAPP group and 1 patient in TEP group were also lost to follow up at 6 months. Apart from statistically significant difference in pain at 24 hours, which was more in TAPP group than TEP group, we found no other significant difference between the two methods.

Conclusions: In this prospective non-randomized study comparing laparoscopic TEP and TAPP repair, for the standard parameters of duration of surgery, conversion, serious adverse event, post-operative pain, local complications, recurrence both locally and port site and length of hospital stay, we had a follow up of 1 year which is adequate for most parameters except recurrence. Our follow up does not allow us to make any conclusion about recurrence. Though the patient numbers are small, our study resonates with the larger studies regarding most parameters. This study leaves us none the wiser as to the superiority of one technique and hence, it is the individual surgeon’s preference and proficiency which dictates the choice of procedure.


Laparoscopic hernia repair, TEP, TAPP, inguinal hernia

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McKernan B. Laparoscopic pre-peritoneal prosthetic repair of inguinal hernias. Surgical Rounds. 1992;7:579-610.

McCormack K, Scott N, Go PM, Ross SJ, Grant A. Laparoscopic techniques versus open techniques for inguinal hernia repair. The Cochrane Library. 2008;4:1-266.

Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant A. Trans-abdominal pre-peritoneal (TAPP) versus totally extra peritoneal (TEP) laparoscopic techniques for inguinal hernia repair. The Cochrane Library. 2008;4:1-25.

Belinsky I, Victor B, David A, Amanda L, Amy E, Todd B. Prospective comparative study of postoperative quality of life in TEP, TAPP, and modified lichtenstein repairs. Ann Surg. 2011;254:709-15.

Langeveld HR, Weidema WF, Laurents PS, Stassen LPS, Steyerberg EW, Lange J, et al. Total extra peritoneal inguinal hernia repair compared with lichtenstein (the LEVEL-Trial) a randomized controlled trial. Ann Surg. 2010;251:819-24.

O’Reilly EA, Burke JP, O’Connell PR. A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia. Ann Surg. 2012;255:846-53.

Zeineldin A. Trans-abdominal (T APP) versus total extra peritoneal (TEP) laparoscopic inguinal hernia repair: a prospective comparative study. Minut Med J. 2008;21:147-54.

Hamza Y, Gabr E, Hammadi H, Khalil R. Four arm randomized trial comparing laparoscopic and open hernia repairs. Egypt J Surg. 2009:28:110-7.

Choksi D, Parmar A, Raiyani G, Prasad G. Comparative prospective study of laparoscopic TEP repair versus laparoscopic TAPP repair for inguinal hernioplasty conducted at tertiary level hospital, Vadodara. Int J Res Med. 2014;3:17-9.

Lal P, Kajla RK, Chander J, Ramteke VK. Laparoscopic total extra-peritoneal (TEP) inguinal hernia repair. Surg Endosc. 2004;18:242-5.

Cohen RV. Laparoscopic inguinal hernioplasty. Surg Laparosc Endosc. 1998;8:264-8.

Krishnan A, Mishra MC, Bansal VK, Kumar S. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc. 2012;26:639-49.

Wong DL, Hockenberry M, Wilson D, Winkelstein ML, Schwartz P. Essential of pediatric nursing. Ed 6 St. Louis; 2001:1301.