TRANS-ABDOMINAL PREPERITONEAL AND TOTALLY EXTRAPERITONEAL LAPAROSCOPIC INGUINAL HERNIA REPAIR :A COMPARATIVE STUDY

Abstract

Laparoscopic repair of inguinal hernia repair has added to the ongoing debate over the ‘‘best groin hernia repair.’’ There are two basic laparoscopic techniques, trans-abdominal pre-peritoneal (TAPP) and total extraperitoneal (TEP). Our study was carried out to compare these two methods of laparoscopic inguinal hernioplasty. Methods: This prospective randomized study was carried out in Surgery Department of Zagazig university hospitals between October 2013 and October 2015 and included 30 patients presenting with primary uncomplicated inguinal hernia. Patients were serially numbered and randomly arranged into two groups; group (A) as TAPP included 15 patients with odd number and group (B) as TEP included 15 patients with even number. All patients were admitted through the outpatient clinic and subjected to detailed history , clinical examination and laboratory work up. Results: Both groups were comparable regarding their demographic profile and hernia characteristics. The majority of hernias were indirect and left sided in both groups. The mean operative time was significantly longer in TAPP group compared to TEP group ( p= 0.045). No major intraoperative complications were recorded apart from minor complications in the form of injury of the inferior epigastric artery ( p= 0.67), pneumoscrotum ( p= 0.62) and surgical emphysema ( p= 0.67) with no significant difference between both groups. Postoperative pain scores recorded the day of surgery were significantly higher in TAPP group patients (p= 0.043) when compared to those in TEP group. They did not however differ significantly between the TEP and TAPP repairs in the 1st postoperative day (p= 0.404). No persistent or serious postoperative complications were recorded apart from mild complications in the form of subcutaneous seroma in the early postoperative period ( p= 0.794) with no significant difference between both groups. The mean postoperative hospital stay was significantly longer in TAPP group compared to TEP group ( p= 0.033) . The mean time interval before return to full activities was significantly longer in TAPP group compared to TEP group ( p= 0.038) . Conclusion: Based on this study, laparoscopic TEP and TAPP repair of inguinal hernia is safe and efficacious. we can conclude that TEP was far better procedure compared to TAPP. According to mean operative time, post-operative pain, post-operative hospital stay and return to normal work, all were far better than TAPP.
Keywords: Laparoscopy, Total Extra-Peritoneal (TEP) repair, Trans Abdominal Pre Peritoneal (TAPP) repair, Inguinal hernia