Two different laparoscopic techniques for repairing a hernia in the groin

An inguinal hernia is a weakness in the wall of the abdominal cavity that is large enough to allow escape of soft body tissue or internal organ, especially a part of the intestine. It usually appears as a lump and for some peoples can cause pain and discomfort, limit daily activities and the ability to work. If the bowel strangulates or becomes obstructed it can be life-threatening. A hernia is repaired generally using a synthetic mesh either with open surgery or increasingly using less invasive laparoscopic procedures. The most common laparoscopic techniques for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. In TAPP the surgeon goes into the peritoneal cavity and places a mesh through a peritoneal incision over possible hernia sites. TEP is different in that the peritoneal cavity is not entered and mesh is used to seal the hernia from outside the peritoneum (the thin membrane covering the organs in the abdomen). This approach is considered to be more difficult than TAPP but may have fewer complications. Laparoscopic repair is technically more difficult than open repair.
The review authors searched the medical literature and found one controlled trial in which 52 mainly male adults were randomised to the two different laparoscopic techniques, carried out by an experienced surgeon. The trial reported that there was no clear difference between TAPP and TEP when considering duration of operation, haemotoma, length of stay, time to return to usual activity or in recurrence of a hernia in the follow-up time of only three months. The authors also looked at non-randomised prospective studies that included more than 500 participants and large prospective case series with greater than 1000 participants for complications and adverse events. From nine studies, a small increase in the number of hernias developing close by and injuries to internal organs were apparent with TAPP and conversions to another type of surgery were more frequent with TEP. These results were broadly consistent. Vascular injuries and deep and mesh infections were rare and there was no obvious difference between the two techniques.