A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair
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Data are insufficient to compare transabdominal preperitoneal repair (TAPP) and total extraperitoneal (TEP) techniques of laparoscopic inguinal hernia repair. There is very scant data comparing the two techniques in terms of long-term outcomes, which include chronic groin pain, quality of life, and time to return to normal activity. This prospective, randomized, controlled trial compared TEP versus TAPP techniques of laparoscopic inguinal hernia repair in terms of these long-term outcomes.
This study was conducted from May 1, 2007 to March 30, 2012. Patients with uncomplicated groin hernia were randomized to transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) techniques. A total of 160 patients were randomized to group I (TEP) and 154 patients to group II (TAPP). Pain was assessed with Visual Analogue Scale (VAS) preoperatively and postoperatively at 24 h, 1 week, 6 weeks, 3, 6, and 12 months, and yearly thereafter. Quality of life was assessed with Short Form–36 version 2 (SF 36v2) preoperatively and postoperatively at 3 months follow-up.
Demographic, clinical profiles, intraoperative, and early postoperative parameters were well matched. There was significantly higher acute pain following TAPP repair; however, the chronic groin pain was comparable in both TEP and TAPP. Preoperative pain and immediate postoperative pain had significant correlation with chronic groin pain. Significant improvement from preoperative to postoperative quality of life was seen in both TEP and TAPP repairs, but there was no difference between TEP and TAPP in postoperative period. Time to return to normal activity also was similar between the two groups.
The TEP and TAPP techniques of laparoscopic repair of inguinal hernia have comparable long-term outcomes in terms of incidence of chronic groin pain, quality of life, and resumption of normal activities. Chronic groin pain had a significant correlation with preoperative pain and early postoperative pain. However, TAPP was associated with significantly higher incidence of early postoperative pain, longer operative time, and cord edema, whereas TEP was associated with a significant higher incidence of seroma formation. The cost was comparable between the two.
KeywordsTEP versus TAPP repair Quality of life Chronic groin pain
Drs. Virinder Kumar Bansal, M.C. Misra, Divya Babu, S. Rajeshwari, Rajesh Sagar, Jonathan Victor, Subodh Kumar, Asuri Krishna, and Vimi Rewari have no competing interest or financial ties to disclose.
- 1.Fitzgobbins RJ, Giobbie-Hurder A, Gibbs JO (2006) Watchful waiting vs repair of inguinal hernia in minimally symptomatic men. A randomized clinical trial. JAMA 295:285–292Google Scholar
- 4.Amid PK, Shulman AG, Lichtenstein IL (1994) The Lichtenstein herniotomy procedure. Chirurg 64:54–58Google Scholar
- 7.Singh AN, Bansal VK, Misra MC, Kumar S, Rajeshwari S, Kumar A, Sagar R, Kumar A (2011) Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial. Surg Endosc [Epub ahead of print] PMID:2208333Google Scholar
- 9.Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 1:CD004703Google Scholar
- 15.Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843PubMedCrossRefGoogle Scholar
- 17.Felix EL, Michas CA, Gonzalez MH Jr (1995) Laparoscopic hernioplasty. TAPP vs TEP. Surg Endosc 9:984–989Google Scholar
- 21.Baca I, Schultz C, Gotzen V, Jazek G (2000) Laparoscopic inguinal hernia repair. A review of 2500 cases. In: Lomanto D, Kum CK, So JBY, Goh PMY, editors. Proceedings of the 7th World Congress of Endoscopic Surgery 425–430Google Scholar
- 22.Lepere M, Benchetrit S, Debaert M et al (2001) A multicentric comparison of transabdominal versus totally extraperitoneal laparoscopic hernia repair using PARIETEX meshes. J Soc Laparoendosc Surg 4:147–153Google Scholar
- 23.Gong K, Zhang N, Lu Y, Zhu B, Zhang Z, Du D, Zhao X, Jiang H (2011) 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 25:234–239PubMedCrossRefGoogle Scholar
- 30.Myers E, Katherine M, Kavanagh D, Hurley M (2010) Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes. 34:3059-3064Google Scholar
- 36.Misra MC, Kumar S, Bansal VK (2008) Total extraperitoneal (TEP) mesh repair of inguinal hernia in the developing world: comparison of low-cost indigenous balloon dissection versus direct telescopic dissection: a prospective randomized controlled study. Surg Endosc 22:1947–1958PubMedCrossRefGoogle Scholar