We want to share an updated Cochrane review: Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair.
Objectives: To compare the benefits and harms of laparoscopic TAPP technique versus laparoscopic TEP technique for inguinal hernia repair in adults.
Main results: 23 randomised controlled trials (RCTs) with 2,266 participants were included. Most participants were men with unilateral inguinal hernias. The systematic review includes rigorously conducted meta-analyses with outcomes ranging from low to very low certainty of evidence.
There seems to be little to no evidence of a difference regarding:
- Hernia recurrence: the anticipated risk was 12 recurrences per 1000 participants receiving TAPP repair (95% CI 5 to 28) and 11 per 1000 receiving TEP repair (17 RCTs, 1712 participants)
- Serious adverse events: the anticipated risk was 4 events per 1000 participants receiving TAPP (95% CI 1 to 16) and 7 per 1000 receiving TEP (19 RCTs, 1735 participants)
Benefits of using TAPP repair:
- The evidence suggests that TAPP has a slightly reduced risk of conversion to another hernia repair method, with an anticipated risk of 7 conversion per 1000 participants (95% CI 2 to 21) versus 25 per 1000 participants receiving TEP (13 RCTs, 1178 participants).
There was very low certainty of evidence regarding chronic pain (OR 0.62, 95% CI 0.20–1.97, I2=0%, 6 RCTs, 860 participants), visceral and vascular injury, and haematoma or seroma.
Authors' conclusion: Considering the low to very low certainty of evidence, the authors concluded that there may be little to no difference between TAPP and TEP repair for serious adverse events, hernia recurrence, and chronic pain. However, surgeons should be aware of the slightly increased risk of conversion during TEP repair and have a strategy prepared for handling conversions. Until high-certainty evidence is available, the choice of repair technique will likely depend on the preferences of surgeons and participants.
Access publication: https://doi.org/10.1002/14651858.CD004703.pub3
