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Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review

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Abstract

Background: The choice of approach to the laparoscopic repair of inguinal hernia is controversial. There is a scarcity of data comparing the laparoscopic transabdominal preperitoneal (TAPP) approach with the laparoscopic totally extraperitoneal (TEP) approach, and questions remain about their relative merits and risks.

Methods: Electronic databases were searched to identify reports of trials comparing laparoscopic TAPP with laparoscopic TEP. In addition, selected conference proceedings were hand-searched, websites consulted, reference lists of all included papers were scanned, and experts contacted for other potentially eligible reports. All published and unpublished randomised controlled trials and quasi-randomised controlled trials comparing laparoscopic TAPP with laparoscopic TEP for inguinal hernia repair were eligible for inclusion. Large non-randomised prospective studies were also eligible for inclusion to provide further comparative evidence of complications and serious adverse events. Two reviewers independently extracted data and assessed study quality. Statistical analyses were performed using the fixed effects model and the results expressed as relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI).

Results: The search identified one RCT which reported no statistically significant difference between TAPP and TEP when considering duration of operation, haematoma, length of stay, time to return to usual activities, and recurrence. The eight non-randomised studies suggest that TAPP is associated with higher rates of port-site hernias and visceral injuries whilst there appear to be more conversions with TEP. Vascular injuries and deep/mesh infections were rare and there was no obvious difference between the groups. No studies reporting economic evidence were identified.

Conclusions: There is insufficient data to allow conclusions to be drawn about the relative effectiveness of TEP compared with TAPP. Efforts should be made to start and complete adequately-powered randomised controlled trials (RCTs), which compare the different methods of laparoscopic repair.

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Acknowledgements

This systematic review was funded by the UK Department of Health and administered by the NHS Executive R&D Health Technology Assessment Programme as a Technology Assessment Review conducted for the National Institute for Clinical Excellence. The Health Services Research Unit and Health Economics Research Unit are funded by the Chief Scientist’s Office of the Scottish Executive Health Department. The views expressed are those of the authors and may not be those of the funding bodies. A more detailed version of this review will be published and updated in the Cochrane Database of Systematic Reviews.

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Authors and Affiliations

  1. Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK

    K. McCormack, B. L. Wake, C. Fraser, L. Vale & A. Grant

  2. Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

    L. Vale & J. Perez

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  1. K. McCormack
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  2. B. L. Wake
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  3. C. Fraser
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  4. L. Vale
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  5. J. Perez
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  6. A. Grant
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Correspondence to K. McCormack.

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McCormack, K., Wake, B.L., Fraser, C. et al. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 9, 109–114 (2005). https://doi.org/10.1007/s10029-004-0309-3

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