A Retrospective Analysis of Laparoscopic Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) Techniques in the Treatment of Unilateral Inguinal Hernias

Abstract

AIM: Inguinal hernia is a common surgical issue, with laparoscopic techniques such as totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) being widely used. However, there is no clear consensus on the superiority of either method for unilateral primary or recurrent inguinal hernias. This study compares TEP and TAPP, focusing on efficacy, safety, and clinical outcomes.

METHODS: This study included patients who underwent elective laparoscopic surgery for unilateral inguinal hernias between April 2009 and May 2024. Patients who underwent inguinal hernia repair were divided into two groups according to whether the TAPP or TEP procedure was used. Primary and recurrent cases were analyzed, with data on demographic features such as age, gender, body mass index (BMI), operative duration, hospital stay, and complications compared between the groups.

RESULTS: Of the 985 patients, 72.6% underwent TAPP and 27.4% underwent TEP. The median BMI was significantly higher in the TAPP group (24.23 [23.4–25.6] vs. 24.00 [23.06–25.62], p = 0.038). The proportion of recurrent hernias was higher in the TEP group (15.6% vs. 9.0%, p = 0.004). Operative time was significantly longer for TEP compared to TAPP (60.0 [40–80] vs. 35.0 [25–45] minutes, p < 0.001). Although the median hospital stay was the same in both groups (1 [1] vs. 1 [1] days), the TAPP group had a wider range of hospital stays (p < 0.001). Complication rates were higher in the TEP group (11.1% vs. 4.3%, p < 0.001), primarily driven by increased seroma formation. Linear regression analysis revealed a significant association between case volume and operative duration for TEP primary cases (p < 0.001, R² = 0.380), recurrent TEP cases (p = 0.024, R² = 0.121), primary TAPP cases (p = 0.017, R² = 0.009), and recurrent TAPP cases (p = 0.627, R² = 0.004).

CONCLUSIONS: Both TAPP and TEP are effective for unilateral inguinal hernia repair; however, TAPP demonstrated shorter operative times, and fewer complications compared to TEP. Case volume significantly influences operative duration, particularly in TEP repairs. Further studies with larger cohorts are warranted to refine surgical approaches and outcomes.