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Transabdominal or totally extraperitoneal laparoscopic hernia repair?
Surgical Laparoscopy & Endoscopy
|August 15, 1998
Summary
Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) laparoscopic inguinal hernia repairs are safe and effective. TAPP offers easier anatomical visualization and a shorter learning curve, making it a suitable option for groin hernia repair.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Laparoscopic hernia repair utilizes prosthetic materials for tension-free repair, promoting early return to work and low recurrence rates.
- The transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches are two primary laparoscopic techniques for inguinal hernia repair.
Purpose of the Study:
- To compare the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) laparoscopic approaches for inguinal hernia repair.
- To evaluate technical feasibility, operative difficulties, patient recovery, and complication rates between TAPP and TEP procedures.
Main Methods:
- A comparative study involving patients undergoing either TAPP (78 patients, 108 hernias) or TEP (67 patients, 100 hernias) for inguinal hernia repair.
- Data collected included operative time, technical difficulties, hospital stay, return to work, intraoperative/postoperative complications, and follow-up.
- Statistical analysis was performed using the Yates-corrected chi-square test, with p < 0.05 considered significant.
Main Results:
- Both TAPP and TEP were frequently used for bilateral and/or recurrent hernias (68%).
- Operative time was shorter in TAPP (not statistically significant), and surgeons reported more technical difficulties with TEP (70% difficulty rate, 4 conversions to TAPP).
- Hospital stay (mean 30 hours) and return to work (TAPP 7 days, TEP 5.5 days) showed no significant difference. Complication rates (TAPP 20.5%, TEP 13.5%) were not statistically different, with no pneumoperitoneum-related issues. TAPP had two trocar site hernias; TEP had one cellulitis. Recurrence rates were not comparable due to differing follow-up periods.
Conclusions:
- Both TAPP and TEP are safe laparoscopic approaches for inguinal hernia repair, offering similar advantages.
- TAPP provides superior anatomical visualization, potentially shortening the learning curve and reducing technical difficulties.
- TAPP is suggested as an adequate laparoscopic approach for groin hernias, though longer follow-up is needed to definitively compare recurrence rates.