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Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair: an update systematic review and meta-analysis of randomized controlled trials

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Abstract

Background

Compared with open herniorrhaphy, laparoscopic herniorrhaphy can yield more favorable clinical outcomes. However, previous studies failed to give definite answer for comparison between laparoscopic inguinal hernia repair approaches. This study aimed to systematically determine the differences in recurrence rate, duration of return to work, pain, surgery duration, and duration of hospital stay between transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approach for inguinal hernia.

Methods

PubMed, Embase, and Cochrane Library (including the Cochrane Central Register of Controlled Trials) abstracts up to September 2017 were searched for randomized controlled trials (RCTs) comparing TAPP or TEP hernia repairing. The hernia recurrence rate, time to return to work, analgesic consumption, surgery duration, hospital stay, and the pain score were recorded with subgroup analysis of the hernia type.

Results

Sixteen RCTs that randomized 1519 patients with hernia into TEP and TAPP repair groups were analyzed in this study. The results revealed that TEP repair resulted in shorter hospital stay of primary cases (MD − 0.87, 95% CI − 1.67 to − 0.07) but was associated with a longer operative duration in recurrent hernia group (MD 3.35, 95% CI 0.16 − 6.54).

Conclusions

TEP and TAPP have their own advantages. TEP repair reduces short-term postoperative pain more effectively than TAPP repair and results in shorter hospital stay of primary cases. In contrast, TAPP repair is correlated with shorter surgery duration. These findings show that shared decision-making regarding both approaches of laparoscopic hernia repair may be needed.

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Author notes

  1. Li-Siou Chen and Wei-Chieh Chen: Co-first authors.

Authors and Affiliations

  1. Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan

    Li-Siou Chen, Yi-No Kang, Chien-Chih Wu & Long-Wen Tsai

  2. School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Li-Siou Chen

  3. Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan

    Wei-Chieh Chen, Chien-Chih Wu & Min-Zhe Liu

  4. Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Yi-No Kang & Chien-Chih Wu

  5. Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chien-Chih Wu

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  1. Li-Siou Chen
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Contributions

L-SC identified evidence systematically, critically appraised the included articles, acquired the data, managed data, and drafted the first version of manuscript. W-CC identified evidence systematically, critically appraised the included articles, interpreted the result of analysis, and critically revised the manuscript. Y-NK designed the study, identified evidence systematically, critically appraised the included articles, analyzed the data, interpreted the result of analysis, critically revised the manuscript, and supervised research. C-CW identified evidence systematically, and critically reviewed the manuscript. L-WT proposed the study, critically reviewed the manuscript. M-ZL interpreted the result of analysis, interpreted the result of analysis, critically reviewed the manuscript, and supervised research.

Corresponding authors

Correspondence to Yi-No Kang or Min-Zhe Liu.

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Disclosures

Li-Siou Chen, Wei-Chieh Chen, Yi-No Kang, Chien-Chih Wu, Long-Wen Tsai, and Min-Zhe Liu have no conflicts of interest or financial ties to disclose.

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Chen, LS., Chen, WC., Kang, YN. et al. Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair: an update systematic review and meta-analysis of randomized controlled trials. Surg Endosc 33, 418–428 (2019). https://doi.org/10.1007/s00464-018-6314-x

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  • DOI: https://doi.org/10.1007/s00464-018-6314-x

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