Clinical Efficacy of Laparoscopic Transabdominal Preperitoneal Versus Totally Extraperitoneal Inguinal Hernia Repair: Meta-analysis of Randomized Controlled Trials

Laparoscopic hernia repair has been shown to be superior to open surgery, and it has become the preferred method for treating inguinal hernia. However, the advantages and disadvantages of laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) inguinal hernia repair—the two most commonly used methods—remain controversial. Most studies of these two operation methods do not clearly present the pros and cons; only studies of curative effects or postoperative complications have provided comparisons. As techniques for laparoscopic inguinal hernia repair continue to be developed and reported in the literature, a meta-analysis might be able to reliably determine the efficacy of different methods. This analysis aims to provide a reliable basis for surgeons and patients to choose between surgical methods. To this end, we retrieved literature that compared TAPP and TEP in terms of the operation time, length of postoperative hospital stay, perioperative complications (surgery change, bleeding, visceral injury), early postoperative complications (seroma, mouth infection, urinary retention), late postoperative complications (recurrence, chronic pain), and resume normal work time. PubMed, Embase, Cochrane Library, Web of Science, and CNKI were searched for randomized controlled trials comparing TAPP and TEP prior to December 15, 2020. Retrieved papers were screened according to established criteria, and those with a quality score of ≥ 4 were included. The papers’ data were extracted, and subgroup analysis of hernia type was performed. Data related to the main comparative results (e.g., operation time, length of postoperative hospital stay, intraoperative complications, postoperative seroma) were recorded. Meta-analysis was performed using RevMan 5.3. Registration number: CRD42021233107; https://www.crd.york.ac.uk/PROSPERO ). A total of 2038 papers were retrieved, and 18 were finally included. Among them, 12,746 patients received TEP, and 14,000 received TAPP. Meta-analysis results showed that TEP reduced the length of postoperative hospital stay compared to TAPP (MD: 8.87; 95% CI: 2.28–15.46; p = 0.008). TEP reduced the incidence of postoperative incision infection compared to TAPP (OR: 2.36; 95% CI: 1.19–4.66; p = 0.01). TAPP reduced the incidence of postoperative seroma compared to TEP (OR: 0.68; 95% CI: 0.50–0.91; p = 0.009). TAPP and TEP are both good surgical methods with their own advantages andisadvantages. TEP can shorten postoperative hospital stay and reduce the postoperative incision infection rate, while TAPP can reduce the incidence of postoperative seroma. In general, the choice between TAPP and TEP should be made jointly by the surgeon and the patient.