Totally extraperitoneal versus transabdominal preperitoneal approach

Background: Laparoscopic groin hernia repair can be done by trans-abdominal pre-peritoneal (TAPP) approach and also by total extra peritoneal (TEP) approach. The objective of this study was to compare the clinical effectiveness and relative efficiency of trans-abdominal pre-peritoneal (TAPP) versus totally extra peritoneal (TEP) techniques of laparoscopic inguinal hernia repair.Methods: All the patients aged 18 years and above admitted in HBT Hospital undergoing laparoscopic inguinal hernia repair were included in this study from June 2014 to January 2016. Diagnosis was made based on history and clinical examination and ultrasound scan of the abdomen. Patients undergoing open hernia surgery and those having contra-indications to laparoscopic hernia repair were excluded from the study. The patients underwent laparoscopic TAPP or laparoscopic TEP repair of hernia based on surgeon’s preference.Results: Total 56 patients were included in the study. It was a non-randomized study, where patients were allocated in TAPP and TEP group based on surgeon’s preference. Hence, 29 patients were included in TAPP group while 27 patients were allocated to TEP group. Post-operatively all patients were evaluated for pain at 6 hours, 12 hours, 24 hours, 1week, 6 months and 1 year. They were also evaluated for length of hospital stay and any operative site complication like hematoma/seroma, wound/mesh infection, recurrence, port site hernia, persisting numbness. 2 patients in TAPP group and 3 in TEP group were lost to follow up at the end of 1 month. Further 4 patients in TAPP group and 1 patient in TEP group were also lost to follow up at 6 months. Apart from statistically significant difference in pain at 24 hours, which was more in TAPP group than TEP group, we found no other significant difference between the two methods.Conclusions: In this prospective non-randomized study comparing laparoscopic TEP and TAPP repair, for the standard parameters of duration of surgery, conversion, serious adverse event, post-operative pain, local complications, recurrence both locally and port site and length of hospital stay, we had a follow up of 1 year which is adequate for most parameters except recurrence. Our follow up does not allow us to make any conclusion about recurrence. Though the patient numbers are small, our study resonates with the larger studies regarding most parameters. This study leaves us none the wiser as to the superiority of one technique and hence, it is the individual surgeon’s preference and proficiency which dictates the choice of procedure.

Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the "best groin hernia repair." The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair. The present prospective randomized study was conducted between May 2007 and March, 2009 and included 100 patients suffering from uncomplicated primary groin hernia. Patients were randomized into group I (TEP) and group II (TAPP). Intraoperative variables and postoperative pain scores were recorded in a prestructured form. One hundred patients were included in the study (TEP, 53; TAPP, 47). Both groups were comparable in terms of demographic profile and hernia characteristics. The average operative time was higher in the TAPP group (p = 0.209). The pain scores at 1 h and 24 h after surgery and at 3-month follow-up were significantly higher in the TAPP group (p < 0.05). The average follow-up was 30.5 months. In the TEP group, 37.8% of patients had seroma compared to 18.3% in the TAPP group (p = 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (16 vs. 9, p = 0.009). The wound infection rates were equal (2% vs. 3%). There has been no recurrence in either group during the follow-up period of 44 months. Overall, the patients were more satisfied with TEP rather than TAPP (p < 0.05). In the present study, TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.

Introduction. Endoscopic procedures for inguinal hernia repair have become widespread. There are many methods of such treatment: transinguinal preperitoneal mesh-plasty (TIPP), TAPP, TEP, MINI (combination of TEP and TAPP). However, the most common among them are TAPP and TEP. Despite the fact that these procedures are now common in many hospitals, the choice of tactics and repair procedures for different types of inguinal hernias is still uncertain. First, it concerns the quality of life of patients.&#x0D; Aim. The aim of this study was to compare TAPP, TEP and Lichtenstein based on quality of life analysis using the EuraHS-QoL scale.&#x0D; Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. Lichtenstein's procedure was performed in 65 patients (Lichtenstein group), transabdominal preperitoneal (TAPP) inguinal hernia repair in 81 patients (TAPP group) and totally extraperitoneal (TEP) inguinal hernia repair in 65 patients (TEP group). We assessed quality of life using a special scale for hernias (EuraHS-QoL). The missing values were treated according to the instructions of the validation study.&#x0D; Results and discussion. As we expected, inguinal hernia repair improved EuraHS-QoL scores in all groups. In the Lichtenstein group, the total mean decreased from 51.2 to 11.8 (4.3 times) (r=-0.13), in the TAPP group – from 51.1 to 9.9 (5.2 times), in the TEP group – from 51.2 to 12.6 (4.1 times). Cosmetic discomfort was highest at the follow-up visit in patients in the Lichtenstein group (4.2). In the TAPP group, this indicator was probably (p&lt;0.05) the smallest (3.0). Low-traumatic methods of operations in modern surgery are priorities today. The Lichtenstein procedure, despite its simplicity, is a traumatic operation compared to TAPP and TEP.&#x0D; Conclusions. Different options for inguinal hernia repair, which are based on the tension-free principle of inguinal canal correction, can be useful. However, when we analyzed the quality of life according to the EuraHS-QoL scale, we decided that transabdominal preperitoneal (TAPP) inguinal hernia repair is the most optimal in terms of various indicators.

Background: Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) mesh repair are two common procedures which are nowadays commonly performed during laparoscopic approaches for inguinal hernias. This randomized prospective study was aimed to compare these two, TAPP and TEP laparoscopic approaches for inguinal hernia repair in terms of various outcomes. Materials and Methods: Patients were randomly picked and 30 (50%) were operated by laparoscopic TAPP hernioplasty and the 30 (50%) by laparoscopic TEP hernioplasty. Results: Both TEP and TAPP mesh repair techniques were comparable in terms of operative time, intraoperative complications, conversion to open, post-operative pain, time to resume normal activity, and recurrence. Duration of hospital stay was significantly more in TAPP group than TEP group. Conclusion: Laparoscopic repair of inguinal hernias is associated comparable results in both techniques TAPP and TEPP and choice between TAPP and TEPP is a personal choice of the concerned surgeon.

Background/Objectives: The study aims to provide a comprehensive understanding of personalized treatment for patients with inguinal hernias at our hospital, focusing on complications, recurrence rates, and hospitalization duration to optimize treatment outcomes. Methods: Our center performs inguinal hernia surgery using an algorithm tailored to individual clinical conditions, developed in collaboration with the anesthesiology department. We retrospectively reviewed outcomes of open, totally extraperitoneal (TEP), and transabdominal preperitoneal (TAPP) approaches, with all procedures performed by a single surgeon. Results: A total of 229 patients (213 males; age range, 24-92 years; median age, 69 years) underwent inguinal hernia repair at Busan National University Hospital between January 2018 and April 2024. Patients in the open group had higher age and comorbidity burden (age/ASA American Society of Anesthesiologists physical status classification: open 74/3.5 vs. TAPP 70/2.0 vs. TEP 68/2.0; p = 0.036/< 0.001). There were no statistically significant differences in intraoperative complications (p = 1.000); however, the conversion rate was slightly higher in the TEP group (TEP 2 vs. TAPP 1). Length of hospital stay was longest in the TAPP group (open 3.77 days vs. TAPP 3.98 days vs. TEP 3.27 days; p = 0.817), while postoperative complication rates did not differ significantly among groups (overall complications: open 15.4% vs. TAPP 6.2% vs. TEP 4.3%; p = 0.100). Conclusions: Laparoscopic surgery is recommended when general anesthesia is feasible, with TEP preferred for patients without previous surgeries and TAPP for those with preperitoneal space (PPS) access challenges due to previous surgeries or radiation therapy. Open surgery is suitable for patients unable to undergo general anesthesia. Anesthesia and surgical approaches should be based on patient preferences and individual clinical conditions.

Laparoscopic inguinal hernia repair utilizes either a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The literature remains mixed on outcomes comparing TAPP versus TEP. The objective of our study was to assess outcomes, healthcare utilization, and cost differences between TAPP and TEP inguinal hernia repair. Adult patients who underwent elective inguinal hernia repair between 2013 and 2021 were retrospectively identified from our institution's electronic health record. Baseline characteristics and postoperative complications were compared using chi-squared test. Multivariable logistic regression was used to model the odds of experiencing a postoperative emergency department visit, readmission, and/or reoperation within 6months were surgery. Generalized linear models were used to investigate differences in cost between TAPP and TEP groups. 1086 patients underwent TAPP repair, while 1277 patients underwent TEP repair. TAPP patients had more than double the rates of readmissions (3.1% vs. 1.3%, p = 0.002) and reoperations (1.5% vs. 0.2%, p = 0.001) within 6months of surgery. On multivariable analysis, undergoing TAPP inguinal hernia repair was associated with higher odds of reoperations and/or readmissions within 6months of surgery (OR 2.8, CI [1.5, 5.1], p = 0.001). TAPP repair had a higher index surgery cost and higher costs associated with reoperations and readmissions compared to TEP repair. Although both approaches are very safe, TAPP inguinal hernia repair had higher rates of postoperative complications, increased healthcare utilization, and higher associated costs. Future studies should be directed toward decreasing postoperative healthcare utilization in order to decrease costs in inguinal hernia repair.

The technical evolution of hernia repair has brought to the introduction of laparoscopy in this field. The most common laparoscopic techniques are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. Indirect comparisons between TAPP and TEP have raised questions as to which is the superior approach in improving patient outcomes; however, there is still a scarcity of data directly comparing these laparoscopic approaches. The aim of this report is to offer a retrospective comparison between the two techniques with a long-term follow-up. This study is a retrospective comparative study, comparing TEP and TAPP in the treatment of groin hernias. All patients undergoing laparoscopic hernia repair from 2015 and 2020 at a large UK Hospital Trust with tertiary referral center, were considered as eligible for inclusion. The primary endpoint was rate of successful surgery defined as absence of recurrence and chronic pain at the end of the follow-up. Secondary endpoints were conversion rate (the switch from TEP to TAPP was considered as a conversion for the index procedure), need for admission, readmission rate, serious adverse events (including visceral injuries and vascular injuries), rate of persisting pain at the end of follow-up, operative time and overall complications rate (hematoma, seroma, wound/superficial infection, mesh/deep infection, port site hernia). Of the patients included in the study who underwent laparoscopic repair of inguinal hernia between 2015 and 2020, 140 (55.1%) underwent TEP and 114 (44.9%) had TAPP repair. The mean operative time did not differ between the two groups (P=0.202). The conversion rate was nil. The two procedures did not differ for intraoperative and postoperative complications. The length of hospital stay was significantly longer in the TAPP group (P<0.0001). The overall recurrence rate was 2.4%. and did not differ between the two groups. Costs were acquired from the clinical coding department. Mean costs were measured in pounds sterling and a significant difference was noted between the two groups (P=0.083). In the short term, the most common complication was seroma formation and was significantly more frequent in the TAPP group (P<0.001). In the long term, chronic pain was the most frequent complication in both groups and significant correlated when the operation performed for recurrent hernia, whereas the hernia Type 3 was a factor that which influenced recurrence. In conclusion, TAPP and TEP have similar, overall complication risks, postoperative acute and chronic pain incidence and recurrence rates. Since TAPP and TEP have comparable outcomes it is recommended that the choice of the technique should be based on the surgeon's skills, education, and experience.

The current prospective randomized controlled clinical study aimed to assess the short- and long-term results of recurrent inguinal hernia repair, and to compare the results for transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) procedures with those for open tension-free repair. For this study, 82 patients were randomly assigned to undergo TAPP (group A, n = 24), TEP (group B, n = 26), or open Lichtenstein hernioplasty (group C, n = 32). All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures. Physical examination showed Nyhus type II hernia in the vast majority of the patients (59%). High-risk patients (American Society of Anesthesiology [ASA] III or IV); coagulation disorders; previous abdominal or pelvic surgery; and irreducible, congenital, and massive scrotal or sliding hernias were excluded from the study. There was a statistically significant difference (p = 0.001) in operating time favoring the open procedure. The intensity of postoperative pain was greater in the open hernia repair group 24 h, 48 h, and 7 days after surgery (p = 0.001), with a greater consumption of pain medication among these patients (p < 0.004). The median time until return to work was 14 days for group A, 13 days for Group g, and 20 days for group C. The comparison was in favor of laparoscopically treated patients. Nine recurrences (4 in the laparoscopic groups and 5 in the open group) were documented within 3 years of follow-up evaluation. Laparoscopic inguinal hernia repair (TAPP or TEP) is the method of choice for dealing with recurrent inguinal hernia.

Background: Surgical repair of inguinal hernia is among the most commonly performed surgical interventions in general surgery clinics, with minimal postoperative complications, less pain, and maximum cosmetic results. The aim of this study is to compare the outcomes of patients who underwent Lichtenstein repair (LR), which is currently the most commonly used open surgical procedure to repair inguinal hernias, and laparoscopic totally extraperitoneal (TEP) repair with regard to postoperative cosmesis, patient satisfaction, pain, and inflammatory response. Patients and Methods: The study consisted of male patients 18-65 years of age, who were operated for inguinal hernia with two different methods between February 2022 and January 2023 in the general surgery clinic of Elazig Fethi Sekin City Hospital. C-reactive protein (CRP), white blood cell, and interleukin 6 (IL-6) levels were observed to evaluate the inflammatory response in all patients. Visual Analog Scale and Verbal Rating Score systems were used to monitor the response to pain in the postoperative period. In addition, both groups were evaluated for patient satisfaction in cosmetic terms using the Vancouver Scar Scale and the Modified Stony Brook Scar Evaluation Scale. Results: Postoperative pain sensation in the TEP group was found to be significantly lower compared to the LR group. In terms of inflammatory response, IL-6 and CRP levels were found to be significantly higher in the LR group on postoperative day 1 and 2. Satisfaction with the cosmetic appearance of the surgical scar was significantly higher in the TEP group. Conclusion: TEP, which is a laparoscopic hernia repair method, is a safe surgical technique that can be preferred, especially in patients with less postoperative pain and higher cosmetic expectations. In terms of inflammatory response, significant difference is also in favor of TEP repair.

Background and Aim: Totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are the two standardized laparoscopic techniques for inguinal hernia repair. Although several studies were conducted in the past, there are still no certain answers regarding the best laparoscopic approach for inguinal hernia repair. Therefore, our aim was to compare the outcomes of the TAPP versus TEP for inguinal hernia. Materials and Methods: This prospective study was conducted at Dayanand Medical College and Hospital, Ludhiana, from January 1, 2018 to March 31, 2019 and included 54 patients admitted with unilateral or bilateral uncomplicated inguinal hernia. Patients undergoing laparoscopic TEP or TAPP inguinal hernia repair were compared on various intraoperative and postoperative parameters. Results: Fifty-four patients were included in the study (TEP, 27; TAPP, 27). Both groups were comparable in terms of demographic profile and hernia characteristics. TEP had significantly less mean operative time compared to TAPP. Pain scores and injectable analgesics’ requirement were significantly higher in TAPP compared to TEP. Postoperative stay was significantly higher in TAPP than TEP. Surgical outcome in terms of intraoperative and postoperative complications, hernia recurrence, and chronic pain for the two laparoscopic techniques was comparable. Conclusion: The lesser intraoperative duration of surgery with lesser postoperative pain scores and lesser postoperative hospital stay favor the use of TEP over TAPP for repair of inguinal hernia.

Background and aim: To find the superiority of extended total extraperitoneal (E-TEP) repair and trans-abdominal pre-peritoneal (TAPP) mesh repair in inguinal hernia repair.Material and methods: A total of 30 patients with a unilateral or bilateral inguinal hernia (IH), and recurrent IH, following open repair were studied. Out of 30 patients, laparoscopic TAPP or E-TEP mesh repair was performed in an equal number of inguinal hernia patients. The patient's demographic parameters, duration of surgery, postoperative hospital stay, and complications were compared.Results: In the E-TEP group, 33.33% of patients had left inguinal hernia (LIH), 60% of patients were diagnosed with right inguinal hernia (RIH) and 6.67% of patients had right inguinal and right direct hernia (RDH). In the TAPP group, 33.33% of patients had LIH and 53.33% of patients were suffering from RIH. Moreover, 6.67% of patients were diagnosed with a left inguinal direct hernia, and a similar proportion of patients had a right inguinal direct hernia. The mean duration of surgery was found to be significantly higher in the TAPP group (P<0.0000). The mean postoperative hospital stay was 2.07±0.59 and 2.80±1.32 days in E-TEP and TAPP groups, respectively (P=0.044).Conclusion: In the present study, E-TEP mesh repair is a superior technique in the management of inguinal hernia as compared with TAPP repair.

We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach. From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed. Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair. The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.

Inguinal hernia is one of the most common cases of elective surgery. Several methods are used to repair inguinal hernia, however, none of these methods have been introduced as the preferred method. Based on this, the current study was designed with the aim of comparing the postoperative short-term complications and recurrence after one year between laparoscopic transabdominal pre-peritoneal (TAPP) and Lichtenstein tension free repair in the treatment of primary unilateral inguinal hernia. In this clinical trial study, 122 patients who were candidates for inguinal hernia surgery in Ahvaz Golestan Hospital, Ahvaz, Southern Iran in 2022 were randomly assigned to two laparoscopic (TAPP) and open (Lichtenstein) surgery groups. Patients were compared in terms of short-term complications (hematoma, infection, seroma), post-surgery pain and number of hospitalization days, surgery duration, scar length and one-year recurrence rate. Wound infection, seroma, and hematoma after surgery in the TAPP group were significantly less than the patients in the Lichtenstein group (P=0.002). Pain intensity, recurrence rate and mean length of surgical scar in laparoscopic group patients were lower than open method group (P=0.001). The mean duration of surgery in the laparoscopic group was higher than the Lichtenstein group, but there was no remarkable difference (P=0.396). The mean duration of surgery in the TAPP group was higher than the Lichtenstein group, but there was no notable difference (P=0.396). The TAPP method has an obvious advantage over the conventional open surgery of Lichtenstein, especially in terms of reducing the initial postoperative pain and the occurrence of complications and recurrence after surgery.

Introduction: Inguinal hernia is one of the most encountered surgical conditions globally - with significant prevalence among adult males. Surgical repair remains the definitive treatment and the two predominant techniques - open Lichtenstein repair and laparoscopic Transabdominal Preperitoneal (TAPP) repair - provide differing profiles in terms of operative time, recovery, pain, complications and cost. In the Indian context - evidence comparing these techniques in a controlled environment remains limited. Objectives: To compare TAPP and Lichtenstein repair techniques in terms of intra-operative and post-operative complications, pain outcomes, operative duration, hospitalization time, cost-effectiveness and recurrence in adult patients undergoing elective inguinal hernia repair. Methodology: This was a prospective, randomized controlled study conducted over 18 months at Sharda Hospital, a tertiary care hospital in Delhi NCR. A total of 45 adult patients with uncomplicated inguinal hernias were randomized into TAPP (n=23) and Lichtenstein (n=22) groups. Data collected included demographic profiles, operative parameters, post-operative complications (up to 6 months), VAS pain scores (post-op days 1 and 7), cost and hospital stay. Statistical analysis was performed using SPSS v29.0 - with p ≤ 0.05 considered significant. Results: TAPP repair showed superior outcomes in pain control with significantly lower VAS scores on day 1 (p&lt;0.0001) and day 7 (p=0.00012). Mean operative time was longer in TAPP (2.08 ± 0.65 hours) vs. Lichtenstein (1.57 ± 0.62 hours) (p=0.0105). Hospital stay was significantly shorter for TAPP (2.04 ± 0.77 days) vs. Lichtenstein (4.95 ± 1.36 days) (p&lt;0.0001). Intra-operative complications were rare, with only one vascular injury in the Lichtenstein group. On day 28, TAPP had lower rates of complications: 8.7% cord thickening and 4.35% each for tenderness and seroma; Lichtenstein had 9.09% SSI and 4.55% recurrence. TAPP incurred higher mean cost (₹20,045.45 ± ₹2,516.18) than Lichtenstein (₹15,909.09 ± ₹1,973.86) (p=0.0001), largely due to use of laparoscopic equipment. Conclusion: TAPP repair provided significantly better postoperative pain control, earlier discharge and reduced complication rates at the cost of longer operative time and higher expenditure. In well-equipped tertiary centres - TAPP is a superior choice for eligible patients and provides clinical benefits that justify the added cost in suitable cases.

Objectives: The aim of the study was to assess the self-perception of dental aesthetics and orthodontic treatment need in a group of young adults. Materials and methods: Perception of dental aesthetics and orthodontic treatment need was assessed among 189 first year university undergraduates using the Oral Aesthetic Subjective Impact Scale (OASIS), a visual analogue scale (VAS), and the Aesthetic component (AC) scale of the Index of Orthodontic treatment Need (IOTN). Data analysis was done using SPSS version 11.0. Descriptive statistics and Chi-square tests were used. One way analysis of variance (ANOVA) was used to identify differences in the mean VAS and OASIS scores according to perceived orthodontic treatment need on the AC scale of IOTN. The relationship between the various scales was examined using correlation tests. Statistical significance was set as p < 0.05. Results: The mean OASIS and VAS scores were 13.61 ± 5.98 and 75.64 ± 18.40 respectively. According to the AC scale of IOTN, 86.8% of participants rated themselves as having no need for treatment, 7.4% borderline need and 5.8% great need for orthodontic treatment. Comparison of mean OASIS and VAS scores according to the AC category showed a trend towards higher mean OASIS scores and lower VAS scores with greater treatment need. ANOVA showed there were significant differences between the AC groups in mean OASIS and VAS scores. Spearman‘s correlation tests between the 3 scales gave low results. Conclusion: There was a low correlation between the OASIS, VAS and AC scale of IOTN in evaluating self-perception of dental aesthetics and orthodontic treatment need. The OASIS and VAS were able to discriminate between participants with different degrees of treatment need.