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TAPP or TEP? Population-Based Analysis of Prospective Data on 4,552 Patients Undergoing Endoscopic Inguinal Hernia Repair

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Abstract

Background

Whether total extraperitoneal inguinal hernia repair (TEP) is associated with worse outcomes than transabdominal preperitoneal inguinal hernia repair (TAPP) continues to be a matter of debate. The objective of this large cohort study is to compare outcomes between patients undergoing TEP or TAPP.

Methods

Based on prospective data of the Swiss association of laparoscopic and thoracoscopic surgery, all patients undergoing unilateral TEP or TAPP between 1995 and 2006 were included. The following outcomes were compared: conversion rates, intraoperative and postoperative complications, duration of operation.

Results

Data on 4,552 patients undergoing TEP (n = 3,457) and TAPP (n = 1,095) were collected prospectively. Average age and American Society of Anesthesiologists score were similar in the two groups. Patients undergoing TEP had a significantly higher rate of intraoperative complications (TEP 1.9 % vs. TAPP 0.9 %, p = 0.029) and surgical postoperative complications (TEP: 2.3 % vs. TAPP: 0.8 %, p = 0.003). The postoperative length of stay was longer for patients undergoing TAPP (2.9 vs. 2.3 days, p = 0.002), whereas the duration of the operation was longer for TEP (66.6 vs. 59.0 min, p < 0.001) and the conversion rate was higher (TEP 1.0 % vs. TAPP 0.2 %, p = 0.011).

Conclusions

This study is one of the first population-based analyses comparing TEP and TAPP in a prospective cohort of more than 4,500 patients. Intraoperative and surgical postoperative complications were significantly higher in patients undergoing TEP. TEP is also associated with longer operating times and higher conversion rates. Therefore, on a population-based level, the TAPP technique appears to be superior to the TEP repair in patients undergoing unilateral inguinal hernia repair.

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Acknowledgments

This study was supported by grants from Johnson & Johnson and Covidien.

Conflict of interest

Drs. Markus Gass, Vanessa Banz, Laura Rosella, Michel Adamina, Daniel Candinas, and Ulrich Güller have no conflicts of interest or financial ties to disclose.

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Correspondence to Ulrich Güller.

Additional information

This work was reported as a podium presentation at the Swiss Surgical Society annual meeting, June 2011, Geneva, Switzerland and as a poster presentation at the Swiss Visceral Surgery Society annual meeting, September 2011, Montreux, Switzerland.

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Gass, M., Banz, V.M., Rosella, L. et al. TAPP or TEP? Population-Based Analysis of Prospective Data on 4,552 Patients Undergoing Endoscopic Inguinal Hernia Repair. World J Surg 36, 2782–2786 (2012). https://doi.org/10.1007/s00268-012-1760-4

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  • DOI: https://doi.org/10.1007/s00268-012-1760-4

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