Transabdominal Pre-Peritoneal Versus Open Repair for Primary Unilateral Inguinal Hernia: A Meta-analysis
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Recent NICE guidelines recommend open surgical approaches for the treatment of primary unilateral inguinal hernias. However, many surgeons perform a laparoscopic approach based on the advantages of less post-operative pain and faster recovery. Our aim was to examine current evidence comparing transabdominal pre-peritoneal (TAPP) laparoscopic repair and open surgical repair for primary inguinal hernias.
A systematic search of six electronic databases was conducted for randomised controlled trials (RCTs) comparing TAPP and open repair for primary unilateral inguinal hernia. A random-effects model was used to combine the data.
A total of 13 RCTs were identified, with 1310 patients receiving TAPP repair and 1331 patients receiving open repair. There was no significant difference between the two groups for rates of haematoma (RR 0.92; 95% CI 0.49–1.71; P = 0.78), seroma (RR 1.90; 95% CI 0.87–4.14; P = 0.10), urinary retention (RR 0.99; 95% CI 0.36–2.76; P = 0.99), infection (RR 0.61; 95% CI 0.29–1.28; P = 0.19), and hernia recurrence (RR 0.67; 95% CI 0.42–1.07; P = 0.10). TAPP repair had a significantly lower rate of paraesthesia (RR 0.20; 95% CI 0.08–0.50; P = 0.0005), shorter bed stay (2.4 ± 1.4 vs 3.1 ± 1.6 days, P = 0.0006), and shorter return to normal activities (9.5 ± 7.9 vs 17.3 ± 8.4 days, P < 0.00001).
Our findings demonstrated that TAPP repair did not have higher rate of morbidity or hernia recurrence and is an equivalent approach to open repair, with the advantages of faster recovery and reduced paraesthesia.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflicts of interest.
Human and animal rights
This article does not contain any studies with human participants or animal performed by any of the authors.
- 3.National Institute for Health and Care Excellence (2016) NICE technology appraisal guidance no. 83: laparoscopic surgery for inguinal hernia repairGoogle Scholar
- 8.Berndsen F, Arvidsson D, Enander LK, Leijonmarck CE, Wingren U, Rudberg C, Smedberg S, Wickbom G, Montgomery A (2002) Postoperative convalescence after inguinal hernia surgery: prospective randomized multicenter study of laparoscopic versus shouldice inguinal hernia repair in 1042 patients. Hernia 6(2):56–61CrossRefPubMedGoogle Scholar
- 15.Gong K, Zhang N, Lu Y, Zhu B, Zhang Z, Du D, Zhao X, Jiang H (2011) Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc 25(1):234–239CrossRefPubMedGoogle Scholar
- 22.Khan N, Babar TS, Ahmad M, Ahmad Z, Shah LA (2013) Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus open Lichtenstein technique. J Postgrad Med Inst 27(3):310–316Google Scholar
- 33.McCormack K, Scott NW, Go PM, Ross S, Grant AM, EU Hernia Trialists Collaboration (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 1:CD001785Google Scholar