A comparative study between totally extraperitoneal and transabdominal preperitoneal laparoscopic inguinal hernia repair techniques

Abstract

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.

New Laparoscopic Surgery in Inguinal Hernia Repair

“…Rhambia et al in 2016 also conducted a comparative study between these techniques; they found that there is no significant difference between them in the variable of duration of surgery, serious adverse event, persisting post-operative pain, hematoma, seroma, persisting numbness, hernia recurrence, port site of hernia and length of hospital stay. TEP gave the patients less pain after 24 hours of surgery in this research [18].…”

Prospective comparison of post-operative quality of life (QOL) after laparoscopic total extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) repair of indirect inguinal hernia

“…The results have been largely non-consistent, with no significant differences between TEP and TAPP. 7,[10][11][12][13] Few studies indicate TEP repair superior to TAPP in terms of postoperative complications, however, learning curve is steeper for TEP, making it a less preferred option as compared to TAPP. [14][15][16] As the era of minimally invasive surgery is advancing, the impact of these techniques on patient's quality of life is necessary to evaluate.…”

Assessment of quality of life after laparoscopic inguinal hernioplasty

“…Наличие боли в 1-й послеоперационный день сопровождалось ограничением подвижности, самообслуживания, невозможностью выполнения повседневных дел, выражалось в низкой оценке состояния пациентами своего здоровья в этот период. Болевой синдром у прооперированных методом ТАПП был более значительным, что, возможно, связано с известными особенностями проведения данного типа герниопластики и обусловлено рассечением париетальной брюшины [1,4,6]. Уже к 3-м суткам интенсивность боли снижалась до умеренной и легкой.…”

“…Операции по поводу паховых грыж продолжают оставаться одними из наиболее частых вмешательств в хирургических стационарах. Многие авторы отмечают, что результаты лечения больных паховыми грыжами в последние годы значительно улучшилисьснизилась частота осложнений, уменьшилось количество рецидивов [1][2][3][4][5][6]. Это прежде всего связано с широким внедрением в практику ненатяжных, протезирующих методик пластики пахового канала.…”

“…Несмотря на более сложные требования, именно эндовидеоскопические способы лечения паховых грыж (трансабдоминальная предбрюшинная герниопластика -ТАПП и тотальная экстраперитонеальная герниопластика -ТЭП), патогенетически обоснованные, обеспечивающие хороший доступ и визуализацию анатомических структур пахового канала, позволяют произвести герниопластику с минимальной травматизацией и наибольшей эффективностью и постепенно занимают лидирующие позиции [1][2][3][4][5]. В различных руководствах и отдельных работах указывается, что оба метода приемлемы для лечения паховой грыжи, однако отмечается, что недостаточно данных, позволяющих сделать вывод о преимуществах того или другого метода по многим критериям, и в частности по качеству жизни пациентов как в ближайшие, так и в отдаленные периоды после вмешательства [3][4][5][6][7].…”