Transabdominal Preperitoneal (TAPP) Versus Totally Extraperitoneal (TEP) for Laparoscopic Hernia Repair: A Meta-Analysis.

Purpose:To perform a meta-analysis of randomized controlled trials (RCTs) comparing transabdominal preperitoneal (TAPP) with totally extraperitoneal (TEP) in regards of hernia recurrence, pain scores, operation time, time to return to usual activities, length of hospital stay, and total complications.Materials and Methods:Online databases including Pubmed, Embase and the Cochrane Library were searched with terms hernia repair, totally extraperitoneal (TEP) repair, and transabdominal preperitoneal (TAPP) repair, as well as the medical subject headings. Relevant RCTs were further analyzed using the methods recommended by the Cochrane Collaboration.Results:A total of 10 RCTs enrolling 1047 patients were included. There was no significant difference in terms of hernia recurrence, pain scores, operation time, time to return to usual activities, hospital stay, total complications, and cost between the 2 groups. Subgroup analysis revealed that pain scores would be affected by many clinical factors, operation time was mainly determined by state and surgeon's experience.Conclusions:On the basis of current evidence, TEP as a modified and more complex laparoscopic procedure than TAPP, did not lead to a significant difference in aspects of clinical outcomes and complications. Therefore, we firstly recommended TAPP for laparoscopic hernia repair, especially for nonexpert surgeons. Further choices would be made according to the specific clinical characteristics of patients and surgeons.