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Transinguinal preperitoneal (TIPP) versus Lichtenstein for inguinal hernia repair: a systematic review and meta-analysis

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Abstract

Purpose

We aimed to perform a systematic review and meta-analysis comparing postoperative outcomes in inguinal hernia repair with TIPP versus Lichtenstein technique.

Methods

Cochrane Central, Scopus, and PubMed were systematically searched for studies comparing TIPP and Lichtenstein´s technique for inguinal hernia repair. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, the Visual Analogue Pain Score, chronic pain, paresthesia rates, and recurrence. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used if I2 > 25%.

Results

790 studies were screened and 44 were thoroughly reviewed. A total of nine studies, comprising 8428 patients were included, of whom 4185 (49.7%) received TIPP and 4243 (50.3%) received Lichtenstein. We found that TIPP presented less chronic pain (OR 0.43; 95% CI 0.20–0.93 P = 0.03; I2 = 84%) and paresthesia rates (OR 0.27; 95% CI 0.07–0.99; P = 0.05; I2 = 63%) than Lichtenstein group. In addition, TIPP was associated with a lower VAS pain score at 14 postoperative day (MD − 0.93; 95% CI − 1.48 to − 0.39; P = 0.0007; I2 = 99%). The data showed a lower operative time with the TIPP technique (MD − 7.18; 95% CI − 12.50, − 1.87; P = 0.008; I2 = 94%). We found no statistical difference between groups regarding the other outcomes analyzed.

Conclusion

TIPP may be a valuable technique for inguinal hernias. It was associated with lower chronic pain, and paresthesia when compared to Lichtenstein technique. Further long-term randomized studies are necessary to confirm our findings.

Study registration A review protocol for this meta-analysis was registered at PROSPERO (CRD42023434909).

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Authors and Affiliations

  1. Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil

    C. A. B. Silveira, A. C. D. Rasador & M. G. Fernandez

  2. Cleveland Clinic, Cleveland, OH, USA

    S. M. Poli de Figueiredo

  3. Washington University in St. Louis, St. Louis, MO, USA

    Y. J. M. Dias

  4. Endocrine Surgery Department, Beth Israel Deaconess Medical Center, Boston, MA, USA

    R. R. H. Martin

  5. University of Texas Medical Branch, Galveston, TX, USA

    R. Lu

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  1. C. A. B. Silveira
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Contributions

Study concept: CABS; Methodology, study selection, and data collection: CABS and YJMD; Statistical analysis: CABS, YJMD and ACDR; Manuscript draft: CABS, SMPF, RRHM, YJMD, and ACDR; Study supervision: SMPF and RL. All authors approved the final version to be published and agreed to be accountable for all aspects of the work related to its accuracy and integrity.

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Correspondence to C. A. B. Silveira.

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R.L received payment/honoraria for lectures and presentations from Intuitive Surgical that are not related to this work. All other authors declare no conflict of interest.

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Silveira, C.A.B., Poli de Figueiredo, S.M., Dias, Y.J.M. et al. Transinguinal preperitoneal (TIPP) versus Lichtenstein for inguinal hernia repair: a systematic review and meta-analysis. Hernia 27, 1375–1385 (2023). https://doi.org/10.1007/s10029-023-02882-0

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