TAPP vs. TEP vs. rTAPP: What Does the Evidence Show?

  • Alexandra Argiroff
  • Diego Camacho


Laparoscopic surgery for repair of inguinal hernias with mesh has been used for over 25 years, since it was first described in 1991 by Shultz. The aim of this chapter is to look at the current data and evidence available comparing the TEP and TAPP techniques for inguinal hernia repair with mesh, as well as a comparison of the laparoscopic repairs to the rTAPP. While there are several studies, including randomized controlled trials and meta-analyses, comparing open and laparoscopic inguinal hernia repairs, there is less data directly comparing the two laparoscopic techniques. There are even fewer studies comparing laparoscopy to the newer rTAPP. In addition to landmark papers, the most current published data will be discussed in this chapter to see what evidence is available to help choose the right minimally invasive technique for both the surgeon and patient.


TAPP TEP rTAPP Laparoscopic surgery Inguinal hernias Mesh 


  1. 1.
    McCormack K, Scott NW, Go PM, Ross S, Grant AM. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;(1):CD001785.
  2. 2.
    Grant AM. Laparoscopic versus open groin hernia repair: meta-analysis of randomised trials based on individual patient data. Hernia. 2002;6(1):2–10. Scholar
  3. 3.
    Schultz L, Graber J, Pietrafitta J, Hickok D. Laser laparoscopic herniorrhaphy: a clinical trial preliminary results. J Laparoendosc Surg. 1990;1(1):41–5. Scholar
  4. 4.
    McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc. 1993;7(1):26–8. Scholar
  5. 5.
    McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Cochrane Database Syst Rev. 2005;9:109. Scholar
  6. 6.
    Schrenk P, Woisetschläger R, Rieger R, Wayand W. Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair. Br J Surg. 1996;83(11):1563–6. Scholar
  7. 7.
    Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) repair of inguinal hernia: a meta-analysis of randomized studies. Surg Endosc Other Interv Tech. 2013;27:S8. Scholar
  8. 8.
    Dedemadi G, Sgourakis G, Karaliotas C, Christofides T, Kouraklis G, Karaliotas C. Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study. Surg Endosc Other Interv Tech. 2006;20(7):1099–104. Scholar
  9. 9.
    Butler RE, Burke R, Schneider JJ, Brar H, Lucha PA. The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded, prospective, randomized trial. Surg Endosc. 2007;21(3):387–90. Scholar
  10. 10.
    Pokorny H, Klingler A, Schmid T, et al. Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia. 2008;12(4):385–9. Scholar
  11. 11.
    Hamza Y, Gabr E, Hammadi H, Khalil R. Four-arm randomized trial comparing laparoscopic and open hernia repairs. Int J Surg. 2010;8(1):25–8. Scholar
  12. 12.
    Gong K, Zhang N, Lu Y, et al. 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 Other Interv Tech. 2011;25(1):234–9. Scholar
  13. 13.
    Krishna A, Misra MC, Bansal VK, Kumar S, Rajeshwari S, Chhabra A. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc Other Interv Tech. 2012;26(3):639–49. Scholar
  14. 14.
    Bansal VK, Misra MC, Babu D, et al. 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. Surg Endosc. 2013;27(7):2373–82. Scholar
  15. 15.
    Köckerling F, Jacob D, Wiegank W, et al. Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: are there differences in the outcome? Surg Endosc Other Interv Tech. 2016;30(3):1146–55. Scholar
  16. 16.
    Gass M, Scheiwiller A, Sykora M, Metzger J. TAPP or TEP for recurrent inguinal hernia? Population-based analysis of prospective data on 1309 patients undergoing endoscopic repair for recurrent inguinal hernia. World J Surg. 2016;40(10):2348–52. Scholar
  17. 17.
    Gass M, Banz VM, Rosella L, Adamina M, Candinas D, Güller U. TAPP or TEP? Population-based analysis of prospective data on 4,552 patients undergoing endoscopic inguinal hernia repair. World J Surg. 2012;36(12):2782–6. Scholar
  18. 18.
    Köckerling F, Bittner R, Kuthe A, et al. TEP or TAPP for recurrent inguinal hernia repair—register-based comparison of the outcome. Surg Endosc. 2017;31(10):3872–82.CrossRefGoogle Scholar
  19. 19.
    Köckerling F, Bittner R, Jacob DA, et al. TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endosc Other Interv Tech. 2015;29(12):3750–60. Scholar
  20. 20.
    Felix EL, Michas CA, Gonzalez MH. Laparoscopic hernioplasty—TAPP vs TEP. Surg Endosc. 1995;9(9):984–9. Scholar
  21. 21.
    Wellwood J, Sculpher MJ, Stoker D, et al. Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. BMJ. 1998;317(7151):103–10.CrossRefGoogle Scholar
  22. 22.
  23. 23.
    Khoury N. A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: a study of 315 cases. J Laparoendosc Adv Surg Tech A. 1998;8(6):367–72. Scholar
  24. 24.
    Bringman S, Ramel S, Heikkinen T-J, Englund T, Westman B, Anderberg B. Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial. Ann Surg. 2003;237(1):142–7. Scholar
  25. 25.
    Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350(18):1819–27. Scholar
  26. 26.
    Li J, Ji Z, Li Y. Comparison of laparoscopic versus open procedure in the treatment of recurrent inguinal hernia: a meta-analysis of the results. Am J Surg. 2014;207(4):602–12. Scholar
  27. 27.
    Cestari A, Galli A, Sangalli M, Zanoni M, Ferrari M, Roviaro G. Totally extraperitoneal (TEP) bilateral hernioplasty using the single site robotic da Vinci platform (DV-SS TEP): description of the technique and preliminary results. Hernia. 2017;21:383. Scholar
  28. 28.
    Kudsi OY, McCarty JC, Paluvoi N, Mabardy AS. Transition from laparoscopic totally extraperitoneal inguinal hernia repair to robotic transabdominal preperitoneal inguinal hernia repair: a retrospective review of a single surgeon’s experience. World J Surg. 2017;41(9):2251–7.CrossRefGoogle Scholar
  29. 29.
    Waite KE, Herman MA, Doyle PJ. Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. J Robot Surg. 2016;10(3):239–44. Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2019

Authors and Affiliations

  • Alexandra Argiroff
    • 1
  • Diego Camacho
    • 1
  1. 1.Department of Surgery, Minimally Invasive and Laparoscopic General SurgeryMontefiore Medical CenterBronxUSA

Personalised recommendations