Comparison of Total Extraperitoneal and Transabdominal Preperitoneal in Laparoscopic Inguinal Herniorrhaphy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 JIANG Ming , JIANG You , WANG Jie , YAO Baozhong , CHEN Hongcun , ZHANG Jun , LI Wenbo , LI Liang.

Department of General Surgery， The Second People’s Hospital of Hefei City， Hefei 230011， Anhui Province， China;

Corresponding author：

JIANG Ming, Email: jiangming8088@yeah.net

Keywords：

Total extraperitoneal hernia repair surgery; Transabdominal preperitoneal hernia repair surgery; Inguinal hernia; Laparoscopy

Video：

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Objective 　To compare the feasibility， safety， and efficiency of laparoscopic total extraperitoneal （TEP）hernia repair surgery and laparoscopic transabdominal preperitoneal （TAPP） hernia repair surgery.
Methods 　The clinical data of 95 patients with inguinal hernia who underwent laparoscopic TEP hernia repair surgery （TEP group） and TAPP hernia repair surgery （TAPP group） from Mar. 2010 to Oct. 2013 in our hospital were retrospectively analyzed， and clinical parameters including operation time， intraoperative blood loss， postoperative hospital stay， postoperative comp-lication， and operation cost of 2 groups were compared.
Results 　All the procedures were successful， none of them was converted to open surgery. There was no significant difference between TEP group and TAPP group when considering operation time 〔（65±16） min vs.（68±17） min〕， intraoperative blood loss 〔（7.0±1.2） mL vs. （8.0±1.4） mL〕， visual pain analogue scale 〔（2.0±1.1） score vs. （1.8±1.1） score〕， postoperative hospital stay 〔（3.1±1.4） d vs. （3.3±1.2） d〕，and time to release to regular activities 〔（4.2±1.0） d vs. （4.5±1.2） d〕， P＞0.05. But the operation cost of TEP group was significantly lower than that of TAPP group 〔（8 033±536） yuan vs. （9 632±643） yuan， P=0.007〕. There were 6 atients （6.3%， 6/95） suffered complications， 3 cases in TEP group and 3 cases in TAPP group， including 3 cases of seroma or hematoma in scrotum， 1 case of transient neurapraxia， and 3 cases of urinary retention. There was no signi-ficant difference in incidence rate of postoperative complication between the 2 groups （P=1.000）. All patients were followed-up for 1-35 months 〔（20.0±10.2） months〕 without recurrence and chronic pain.
Conclusions 　TEP and TAPP hernia repair surgery are feasible， safe， effective， and minimally invasive technique for inguinal hernioplasty. There are advantages and disadvantages of both TAPP and TEP hernia repair surgery， but there is no statistically significant difference regarding intraoperative and postoperative complications.

Citation： JIANG Ming,JIANG You,WANG Jie,YAO Baozhong,CHEN Hongcun,ZHANG Jun,LI Wenbo,LI Liang.. Comparison of Total Extraperitoneal and Transabdominal Preperitoneal in Laparoscopic Inguinal Herniorrhaphy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(12): 1391-1395. doi: Copy

1.	Lichtenstein IL， Shulman AG， Amid PK， et al. The tension-free hernioplasty[J]. Am J Surg， 1989， 157(2)：188-193.
2.	Schultz LS， Graber JN， Pietrafitta J， et al. Early results with laparoscopic inguinal herniorrhaphy are promising[J]. Clin LaserMon， 1990， 8(7)：103-105.
3.	中华医学会外科学会疝和腹壁外科学组. 成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003年修订稿)[J]. 中华外科杂志， 2004， 42(14)：834-835.
4.	McKernan JB， Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg End-osc， 1993， 7(1)：26-28.
5.	Dion YM， Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg， 1992， 35(2)：209-212.
6.	Morales-Conde S， Socas M， Fingerhut A. Endoscopic surgeons’preferences for inguinal hernia repair：TEP， TAPP， or OPEN[J].Surg Endosc， 2012， 26(9)：2639-2643.
7.	李健文，王映昌，张凌捷，等. 腹股沟疝腹腔镜手术在我国逐步推广的可行性探讨[J]. 外科理论与实践， 2010， 15(6)：611-615.
8.	Gass M， Banz VM， Rosella L， et al. TAPP or TEP? Population-based analysis of prospective data on 4 552 patients undergoing endoscopic inguinal hernia repair[J]. World J Surg， 2012， 36(12)：2782-2786.
9.	McCormack K， Wake B， Perez J， et al. Laparoscopic surgery for inguinal hernia repair：systematic review of effectiveness and economic evaluation[J]. Health Technol Assess， 2005， 9(14)：1-203.
10.	Kapiris SA， Brough WA， Royston CM， et al. Laparoscopic transa-bdominal preperitoneal (TAPP) hernia repair. A 7-year two-center experience in 3 017 patients[J]. Surg Endosc， 2001， 15(9)：972-975.
11.	Campanelli G， Pettinari D， Cavalli M， et al. Inguinal herniarecurrence：classification and approach[J]. J Minim Access Surg， 2006， 2(3)：147-150.
12.	Bittner R， Schmedt CG， Schwarz J， et al. Laparoscopic transperitoneal procedure for routine repair of groin hernia[J]. Br J Surg， 2002， 89(8)：1062-1066.
13.	Leibl BJ， Schmedt CG， Kraft K， et al. Scrotal hernias：a contr-aindication for an endoscopic procedure? Results of a single-insti-tution experience in transabdominal preperitoneal repair[J]. SurgEndosc， 2000， 14(3)：289-292.
14.	Bittner R， Arregui ME， Bisgaard T， et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia 〔International Endohernia Society (IEHS)〕[J]. Surg Endosc， 2011， 25(9)：2773-2843.
15.	Chowbey PK， Bandyopadhyay SK， Sharma A， et al. Recurrent hernia following endoscopic total extraperitoneal repair[J]. J Laparoendosc Adv Surg Tech A， 2003， 13(1)：21-25.
16.	Mirilas P， Colborn GL， McClusky DA 3rd， et al. The history of anatomy and surgery of the preperitoneal space[J]. Arch Surg， 2005， 140(1)：90-94.
17.	Zanghì A， Di Vita M， Lo Menzo E， et al. Multicentric evaluationby Verbal Rate Scale and EuroQoL-5D of early and late post-oper-ative pain after TAPP and TEP procedures with mechanical fixationfor bilateral inguinal hernias[J]. Ann Ital Chir， 2011， 82(6)：437-442.
18.	Krishna A， Misra MC， Bansal VK， et al. Laparoscopic inguinal hernia repair：transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach：a prospective randomized contro-lled trial[J]. Surg Endosc， 2012， 26(3)：639-649.
19.	Bracale U， Melillo P， Pignata G， et al. Which is the best laparos-copic approach for inguinal hernia repair：TEP or TAPP? A syste-matic review of the literature with a network meta-analysis[J]. Surg Endosc， 2012， 26(12)：3355-3366.
20.	Robert JJ， Greenburg AG著，马颂章译[M]. 第5版. 北京：人民卫生出版社， 2003：293-299.
21.	Garg P， Rajagopal M， Varghese V， et al. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1 692 hernias[J]. Surg Endosc， 2009， 23(6)：1241-1245.
22.	Olmi S， Erba L， Bertolini A， et al. Fibrin glue for mesh fixationin laparoscopic transabdominal preperitoneal (TAPP) hernia repair：indications， technique， and outcomes[J]. Surg Endosc， 2006， 20(12)：1846-1850.
23.	江鸣，张军，陈宏存，等. 肌耻骨孔在腹腔镜腹股沟疝修补术中的临床意义[J]. 中华疝和腹壁外科杂志：电子版， 2012， 6(4)：950-954.
24.	曾辉，郑本波，李锋，等. 腹膜前间隙在腹腔镜TAPP及TEP疝修补术中的重要作用(附66例报道)[J]. 中国普外基础与临床杂志， 2012， 19(9)：980-983.
25.	林志华. 腹腔镜腹股沟疝修补术经腹腔腹膜前与完全腹膜外手术入路疗效的meta分析[J]. 中国普外基础与临床杂志， 2013， 20(5)：517-524.
26.	臧潞，李健文，毛志海，等. 腹腔镜完全腹膜外与经腹腹膜前疝修补术临床对照分析[J]. 中国实用外科杂志， 2005， 25(10)：611-613.

1. Lichtenstein IL， Shulman AG， Amid PK， et al. The tension-free hernioplasty[J]. Am J Surg， 1989， 157(2)：188-193.
2. Schultz LS， Graber JN， Pietrafitta J， et al. Early results with laparoscopic inguinal herniorrhaphy are promising[J]. Clin LaserMon， 1990， 8(7)：103-105.
3. 中华医学会外科学会疝和腹壁外科学组. 成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003年修订稿)[J]. 中华外科杂志， 2004， 42(14)：834-835.
4. McKernan JB， Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg End-osc， 1993， 7(1)：26-28.
5. Dion YM， Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg， 1992， 35(2)：209-212.
6. Morales-Conde S， Socas M， Fingerhut A. Endoscopic surgeons’preferences for inguinal hernia repair：TEP， TAPP， or OPEN[J].Surg Endosc， 2012， 26(9)：2639-2643.
7. 李健文，王映昌，张凌捷，等. 腹股沟疝腹腔镜手术在我国逐步推广的可行性探讨[J]. 外科理论与实践， 2010， 15(6)：611-615.
8. Gass M， Banz VM， Rosella L， et al. TAPP or TEP? Population-based analysis of prospective data on 4 552 patients undergoing endoscopic inguinal hernia repair[J]. World J Surg， 2012， 36(12)：2782-2786.
9. McCormack K， Wake B， Perez J， et al. Laparoscopic surgery for inguinal hernia repair：systematic review of effectiveness and economic evaluation[J]. Health Technol Assess， 2005， 9(14)：1-203.
10. Kapiris SA， Brough WA， Royston CM， et al. Laparoscopic transa-bdominal preperitoneal (TAPP) hernia repair. A 7-year two-center experience in 3 017 patients[J]. Surg Endosc， 2001， 15(9)：972-975.
11. Campanelli G， Pettinari D， Cavalli M， et al. Inguinal herniarecurrence：classification and approach[J]. J Minim Access Surg， 2006， 2(3)：147-150.
12. Bittner R， Schmedt CG， Schwarz J， et al. Laparoscopic transperitoneal procedure for routine repair of groin hernia[J]. Br J Surg， 2002， 89(8)：1062-1066.
13. Leibl BJ， Schmedt CG， Kraft K， et al. Scrotal hernias：a contr-aindication for an endoscopic procedure? Results of a single-insti-tution experience in transabdominal preperitoneal repair[J]. SurgEndosc， 2000， 14(3)：289-292.
14. Bittner R， Arregui ME， Bisgaard T， et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia 〔International Endohernia Society (IEHS)〕[J]. Surg Endosc， 2011， 25(9)：2773-2843.
15. Chowbey PK， Bandyopadhyay SK， Sharma A， et al. Recurrent hernia following endoscopic total extraperitoneal repair[J]. J Laparoendosc Adv Surg Tech A， 2003， 13(1)：21-25.
16. Mirilas P， Colborn GL， McClusky DA 3rd， et al. The history of anatomy and surgery of the preperitoneal space[J]. Arch Surg， 2005， 140(1)：90-94.
17. Zanghì A， Di Vita M， Lo Menzo E， et al. Multicentric evaluationby Verbal Rate Scale and EuroQoL-5D of early and late post-oper-ative pain after TAPP and TEP procedures with mechanical fixationfor bilateral inguinal hernias[J]. Ann Ital Chir， 2011， 82(6)：437-442.
18. Krishna A， Misra MC， Bansal VK， et al. Laparoscopic inguinal hernia repair：transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach：a prospective randomized contro-lled trial[J]. Surg Endosc， 2012， 26(3)：639-649.
19. Bracale U， Melillo P， Pignata G， et al. Which is the best laparos-copic approach for inguinal hernia repair：TEP or TAPP? A syste-matic review of the literature with a network meta-analysis[J]. Surg Endosc， 2012， 26(12)：3355-3366.
20. Robert JJ， Greenburg AG著，马颂章译[M]. 第5版. 北京：人民卫生出版社， 2003：293-299.
21. Garg P， Rajagopal M， Varghese V， et al. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1 692 hernias[J]. Surg Endosc， 2009， 23(6)：1241-1245.
22. Olmi S， Erba L， Bertolini A， et al. Fibrin glue for mesh fixationin laparoscopic transabdominal preperitoneal (TAPP) hernia repair：indications， technique， and outcomes[J]. Surg Endosc， 2006， 20(12)：1846-1850.
23. 江鸣，张军，陈宏存，等. 肌耻骨孔在腹腔镜腹股沟疝修补术中的临床意义[J]. 中华疝和腹壁外科杂志：电子版， 2012， 6(4)：950-954.
24. 曾辉，郑本波，李锋，等. 腹膜前间隙在腹腔镜TAPP及TEP疝修补术中的重要作用(附66例报道)[J]. 中国普外基础与临床杂志， 2012， 19(9)：980-983.
25. 林志华. 腹腔镜腹股沟疝修补术经腹腔腹膜前与完全腹膜外手术入路疗效的meta分析[J]. 中国普外基础与临床杂志， 2013， 20(5)：517-524.
26. 臧潞，李健文，毛志海，等. 腹腔镜完全腹膜外与经腹腹膜前疝修补术临床对照分析[J]. 中国实用外科杂志， 2005， 25(10)：611-613.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Total Extraperitoneal and Transabdominal Preperitoneal in Laparoscopic Inguinal Herniorrhaphy

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