Skip to main content


Log in

Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript



Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the “best groin hernia repair.” The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair.


The present prospective randomized study was conducted between May 2007 and March, 2009 and included 100 patients suffering from uncomplicated primary groin hernia. Patients were randomized into group I (TEP) and group II (TAPP). Intraoperative variables and postoperative pain scores were recorded in a prestructured form.


One hundred patients were included in the study (TEP, 53; TAPP, 47). Both groups were comparable in terms of demographic profile and hernia characteristics. The average operative time was higher in the TAPP group (p = 0.209). The pain scores at 1 h and 24 h after surgery and at 3-month follow-up were significantly higher in the TAPP group (p < 0.05). The average follow-up was 30.5 months. In the TEP group, 37.8% of patients had seroma compared to 18.3% in the TAPP group (p = 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (16 vs. 9, p = 0.009). The wound infection rates were equal (2% vs. 3%). There has been no recurrence in either group during the follow-up period of 44 months. Overall, the patients were more satisfied with TEP rather than TAPP (p < 0.05).


In the present study, TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Bassini E (1887) Nuovo metodo sulla cura radicale dell’ernia inguinale. Arch Soc Ital Chir 4:380

    Google Scholar 

  2. [No authors listed] (1999) Laparoscopic versus open repair of groin hernia: a randomized comparison. The MRC Laparoscopic Groin Hernia Trial Group. Lancet 354:185–190

    Google Scholar 

  3. Neumayer L, Giobbie-Hurder A, Jonasson O (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827

    Article  PubMed  CAS  Google Scholar 

  4. National Institute for Clinical Excellence (2001) Guidance on the use of laparoscopic surgery for inguinal hernia, technological appraisal guidance No. 18. NICE, London

    Google Scholar 

  5. Arregui ME, Davis CJ, Yucel O, Nagan RF (1992) Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach: a preliminary report. Surg Laparosc Endosc 2:53–58

    PubMed  CAS  Google Scholar 

  6. McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7:26–28

    Article  PubMed  CAS  Google Scholar 

  7. Camps J, Nguyen N, Annabali R, Fitzgibbons RJ Jr (1995) Laparoscopic inguinal herniorrhaphy: transabdominal techniques. Int Surg 80:18–25

    PubMed  CAS  Google Scholar 

  8. Corbitt JD (1993) Transabdominal preperitoneal herniorrhaphy. Surg Laparosc Endosc 3:328–332

    PubMed  Google Scholar 

  9. Misra MC, Bansal VK, Kumar S, Prashant B, Bhattacharjee HK (2008) Total extra-peritoneal repair of groin hernia: prospective evaluation at a tertiary care center. Hernia 12:65–71

    Article  PubMed  CAS  Google Scholar 

  10. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP). Cochrane Database Syst Rev (1):CD004703

  11. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193

    Article  PubMed  CAS  Google Scholar 

  12. Ferzli G, Masaad A, Albert P, Worth MH (1993) Endoscpoic extraperitoneal herniorrhaphy versus conventional hernia repair: a comparative study. Curr Surg 50:291–294

    Google Scholar 

  13. Khoury N (1995) A comparative study of laparoscopic extraperitoneal and transabdominal preperitoneal herniorrhaphy. J Laparoendosc Surg 56:349–355

    Article  Google Scholar 

  14. Felix EL, Harbertson N, Vartanian S (1999) Laparoscopic hernioplasty: significant complications. Surg Endosc 13:328–331

    Article  PubMed  CAS  Google Scholar 

  15. Bringman S, Blomqvist P (2005) Intestinal obstruction after inguinal and femoral hernia repair: a study of 33, 275 operations during 1992–2000 in Sweden. Hernia 9:178–183

    Article  PubMed  CAS  Google Scholar 

  16. Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A (2000) Groin hernia repair in Scotland. Br J Surg 87:1722–1726

    Article  PubMed  CAS  Google Scholar 

  17. Cohen RV (1998) Laparoscopic extraperitoneal repair of inguinal hernias. Surg Laparosc Endosc 8:14–16

    Article  PubMed  CAS  Google Scholar 

  18. Felix EL, Michas CA, Gonzalez MH Jr (1995) Laparoscopic hernioplasty: TAPP vs TEP. Surg Endosc 9:984–989

    PubMed  CAS  Google Scholar 

  19. Van Hee R, Goverde P, Hendrickx L, Van der Schelling G, Totte E (1998) Laparoscopic transperitoneal versus extraperitoneal inguinal hernia repair: a prospective clinical trial. Acta Chir Belg 98:132–135

    PubMed  Google Scholar 

  20. 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 (eds) Proceedings of the 7th world congress of endoscopic surgery, Singapore, June 1–4, 2000. Monduzzi editore, Bologna, Italy, pp 425–430

    Google Scholar 

  21. Tamme C, Scheidbach H, Hampe C, Schneider C, Kockerling F (2003) Totally extraperitoneal endsocopic inguinal hernia repair (TEP). Surg Endosc 17:190–195

    Article  PubMed  CAS  Google Scholar 

  22. Leibl BJ, Schmedt CG, Ulrich M, Kraft K, Bittner R (2000) Laparoscopic hernia therapy (TAPP) as a teaching operation. Chirurg 71:939–942

    Article  PubMed  CAS  Google Scholar 

  23. Dalessandri KM, Bhoyrul S, Mulvihill SJ (2001) Laparoscopic hernia repair and bladder injury. JSLS 5:175–177

    PubMed  CAS  Google Scholar 

  24. Moreno-Egea A, Aguayo JL, Canteras M (2000) Intraoperative and postoperative complications of totally extraperitoneal laparoscopic inguinal hernioplasty. Surg Laparosc Endosc Percutan Tech 10:30–33

    PubMed  CAS  Google Scholar 

  25. 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 22:1947–1958

    Article  PubMed  Google Scholar 

  26. Lau H, Lee F (2003) Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 17:1773–1777

    Article  PubMed  CAS  Google Scholar 

  27. Lepere M, Benchetrit S, Debaert M, Detruit B, Dufilho A, Gaujoux D (2000) A multicentric comparison of transabdominal versus totally extraperitoneal laparoscopic hernia repair using PARIETEX meshes. JSLS 4:147–153

    PubMed  CAS  Google Scholar 

  28. Lau H, Patil NG, Yuen WK, Lee F (2003) Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 17:1620–1623

    Article  PubMed  CAS  Google Scholar 

  29. Poobalan A, Bruce T, King PM, Chambers WA, Krukowski ZH, Smith WCS (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88:1122–1126

    Article  PubMed  CAS  Google Scholar 

  30. Page B, Paterson C, Young D (2002) Pain from primary inguinal hernia and the effect of repair on pain. Br J Surg 89:1315–1318

    Article  PubMed  CAS  Google Scholar 

  31. Bringman S, Ek A, Haglind E, Heikkinen T, Kald A, Kylberg F, Ramel S, Wallon C (2001) Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study. Surg Endosc 15:266–270

    Article  PubMed  CAS  Google Scholar 

  32. Knook MT, Weidema WF, Stassen LP (1999) Endoscopic total extraperitoneal repair of bilateral inguinal hernias. Br J Surg 86:1312–1316

    Article  PubMed  CAS  Google Scholar 

  33. Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ (1998) Randomised controlled trial of laparoscopic versus open mesh repair of inguinal hernia: outcome and cost. BMJ 12:317–331

    Google Scholar 

  34. Fitzgibbons RJ Jr, Puri V (2006) Laparoscopic inguinal hernia repair. Am Surg 72:197–206

    PubMed  Google Scholar 

  35. Weiser HF, Klinge B (2000) Endoscopic hernia repair - experiences and characteristic features. Viszeralchirurgie 35:316–320

    Article  Google Scholar 

  36. Lehr SC, Schuricht AL (2001) A minimally invasive approach for treating postoperative seromas after incisional hernia repair. JSLS 5:267–271

    PubMed  CAS  Google Scholar 

  37. Srivastava A, Srinivas G, Misra MC, Pandav CS, Seenu V, Goyal A (2001) Cost effectiveness analysis of laparoscopic versus minilaparotomy cholecystectomy for gallstone disease. Int J Technol Assess Health Care 17:497–502

    PubMed  CAS  Google Scholar 

Download references


Dr. Asuri Krishna, Dr. M. C. Misra, Dr. Virinder Kumar Bansal, Dr. Subodh Kumar, Dr. S. Rajeshwari, and Dr. Anjolie Chabra have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations


Corresponding author

Correspondence to M. C. Misra.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krishna, A., Misra, M.C., Bansal, V.K. et al. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 26, 639–649 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: