Totally Extraperitoneal vs Transabdominal Preperitoneal Approach: Which Way Should One Go?

Introduction: Inguinal hernia surgery is now commonly performed laparoscopically all over the world either by transabdominal preperitoneal approach (TAPP) or totally extraperitoneal (TEP) approach. Because of the lack of consistency in comparative literature and data, further studies are required. Methods: This prospective study was conducted on 176 patients of age 18 years and older with an inguinal hernia, who were randomly allocated to TEP and TAPP groups respectively to determine the intraoperative and postoperative outcomes in terms of operative time, pain, intraoperative complication, and conversion to open surgery, postoperative complication, length of hospital stay, chronic pain and recurrence of the hernia. Results: The mean operative time was 91.14 ± 11.14 minutes in TEP and 103.16 ± 6.79 minutes in TAPP, which was found to be significant; The mean pain scores (Visual Analogue Scale) on postoperative day 1 and day 2 were 5.70 ± 0.95 and 3 ± 1.27 in the TEP group while it was 5.86 ± 0.97 and 2.95 ± 1.29 in the TAPP group respectively. There was no statistically significant difference between TEP and TAPP for postoperative pain, duration of hospital stay, time to return to work, chronic pain, and recurrences. TAPP was associated with a slightly longer operative time compared with TEP. Recurrence was observed in one case of the TEP group during follow-up. Conclusion: TEP and TAPP offer excellent treatment options for inguinal hernia repair with almost similar results. The outcome after either laparoscopic hernia repair was quite reasonably acceptable by the patients.