Laparoscopic Transabdominal Preperitoneal Versus Totally Extraperitoneal Approach of Inguinal Hernia Repair：A Meta Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIN Zhihua

Department of General Surgery， The First Affiliated Hospital of Shantou University Medical College， Shantou 515041， Guangdong Province， China;

Corresponding author：

Keywords：

Laparoscopy; Totally extraperitoneal; Transabdominal preperitoneal; Inguinal hernia; Meta-analysis

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Objective 　To evaluate the clinical application of the different operative approaches of the laparoscopic
repair of inguinal hernia and provide a more rational and scientific choice for the surgeon.
Methods 　The strict inclusion and exclusion criteria were set up. All the randomized controlled trials （RCT） about laparoscopic transabdominal preperi-toneal （TAPP） and totally extraperitoneal （TEP） approaches of laparoscopic inguinal hernia repair were collected. Meta an-alysis was performed according to the recommendation by the Cochrane handbook.
Results 　Seven RCTs including 552 patients were analyzed， who were divided into TAPP group （n=302） and TEP group （n=250）. Compared with TAPP group， there were no significant differences of the operation time〔WMD=8.49， 95% CI （-1.37， 18.35）， P=0.09〕， postoperative hospitalization〔SMD=0.11， 95% CI （-0.12， 0.34）， P=0.34〕， postoperative recurrence rate 〔OR=1.37， 95% CI （0.36， 5.20）， P=0.64〕， and complications （incision infection， urinary retention）〔Incision infection：OR=4.27， 95% CI （0.85， 21.57）， P=0.08；Urinary retention：OR=0.61， 95% CI （0.21， 1.78）， P=0.36〕in the TEP group. But the postoperative 24 h pain in the TEP group was significantly milder than that in the TAPP group 〔WMD=0.72， 95% CI （0.58， 0.87）， P＜0.000 01〕.
Conclusions 　The currently available evidence shows that postoperative 24 h pain in the TEP group is more milder than that in the TAPP group. The time of the operation， postoperative hospitalization， postoperative recurrence， and complications are no significant differences between TAPP group and TEP group. Large-scale， high-quality RCTs are still needed to confirm or refuse the available evidence.

Citation： LIN Zhihua. Laparoscopic Transabdominal Preperitoneal Versus Totally Extraperitoneal Approach of Inguinal Hernia Repair：A Meta Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(5): 517-524. doi: Copy

1.	Ger R. The management of certain abdominal herniae by intra-abdominal closure of the neck of the sac. Preliminary communication[J]. Ann R Coll Surg Engl， 1982， 64(5)：342-344.
2.	Dion YM， Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg， 1992， 35(2)：209-212.
3.	McKernan JB， Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. SurgEndosc， 1993， 7(1)：26-28.
4.	McCormack K， Wake BL， Fraser C， et al. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopictechniques for inguinal hernia repair：a systematic review[J]. Hernia， 2005， 9(2)：109-114.
5.	Wake BL， McCormack K， Fraser C， et al. Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair[J]. Cochrane Database Syst Rev， 2005， (1)：CD004703.
6.	Krishna A， Misra MC， Bansal VK， et al. Laparoscopic inguinal hernia repair：transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach：a prospective randomized contr-olled trial[J]. Surg Endosc， 2012， 26(3)：639-649.
7.	Gong K， Zhang N， Lu Y， et al. Comparison of the open tension-free mesh-plug， transabdominal preperitoneal (TAPP)， and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial[J]. Surg Endosc， 2011， 25(1)：234-239.
8.	Hamza Y， Gabr E， Hammadi H， et al. Four-arm randomized trial comparing laparoscopic and open hernia repairs[J]. Int J Surg， 2010， 8(1)：25-28.
9.	毛志海，李健文，王明亮，等. 两种不同腔镜腹股沟疝修补术CO_2充气对血流动力学与呼吸功能的影响[J]. 外科理论与实践， 2008， 13(3)：223-226.
10.	Pokorny H， Klingler A， Schmid T， et al. Recurrence and compli-cations after laparoscopic versus open inguinal hernia repair：results of a prospective randomized multicenter trial[J]. Hernia， 2008， 12(4)：385-389.
11.	Günal O， Ozer S， Gürleyik E， et al. Does the approach to the groin make a difference in hernia repair?[J]. Hernia， 2007， 11(5)：429-434.
12.	Schrenk P， Woisetschläger R， Rieger R， et al. Prospective rand-omized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal， total preperitoneal or Shouldice technique for inguinal hernia repair[J]. Br J Surg， 1996， 83(11)：1563-1566.
13.	Edwards CC 2nd， Bailey RW. Laparoscopic hernia repair：the learning curve[J]. Surg Laparosc Endosc Percutan Tech， 2000， 10(3)：149-153.
14.	Dulucq JL， Wintringer P， Mahajna A. Laparoscopic totallyextraperitoneal inguinal hernia repair：lessons learned from 3 100 hernia repairs over 15 years[J]. Surg Endosc， 2009， 23(3)：482-486.
15.	刘伟红，杨彪，徐静. 腹腔镜腹股沟疝修补术网片钉合技术与免钉合技术疗效比较的系统评价[J]. 第二军医大学学报， 2010， 31(12)：1337-1340.
16.	Lau H， Patil NG. Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty：multivariate analysis of predictive factors[J]. Surg Endosc， 2004， 18(1)：92-96.
17.	Neumayer L， Fitzgibbons R Jr， Itani K， et al. Laparoscopic inguinal hernia repair[J]. J Am Coll Surg， 2005， 201(3)：486-487.
18.	Phillips EH， Rosenthal R， Fallas M， et al. Reasons for earlyrecurrence following laparoscopic hernioplasty[J]. Surg Endosc，.
19.	Sayad P， Hallak A， Ferzli G. Laparoscopic herniorrhaphy：reviewof complications and recurrence[J]. J Laparoendosc Adv Surg Tech A， 1998， 8(1)：3-10.
20.	Lepere M， Benchetrit S， Debaert M， et al. A multicentric comparison of transabdominal versus totally extraperitoneal laparoscopic hernia repair using PARIETEX meshes[J]. JSLS， 2000， 4(2)：147-153.
21.	Lau H， Patil NG， Yuen WK， et al. Urinary retention following endoscopic totally extraperitoneal inguinal hernioplasty[J]. Surg Endosc， 2002， 16(11)：1547-1550.
22.	Hussain A， Nicholls J， El-Hasani S. Technical tips following more than 2 000 transabdominal preperitoneal (TAPP) repair of the groin hernia[J]. Surg Laparosc Endosc Percutan Tech， 2010， 20(6)：384-388.
23.	， 9(2)：140-145.

1. Ger R. The management of certain abdominal herniae by intra-abdominal closure of the neck of the sac. Preliminary communication[J]. Ann R Coll Surg Engl， 1982， 64(5)：342-344.
2. Dion YM， Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg， 1992， 35(2)：209-212.
3. McKernan JB， Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. SurgEndosc， 1993， 7(1)：26-28.
4. McCormack K， Wake BL， Fraser C， et al. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopictechniques for inguinal hernia repair：a systematic review[J]. Hernia， 2005， 9(2)：109-114.
5. Wake BL， McCormack K， Fraser C， et al. Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair[J]. Cochrane Database Syst Rev， 2005， (1)：CD004703.
6. Krishna A， Misra MC， Bansal VK， et al. Laparoscopic inguinal hernia repair：transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach：a prospective randomized contr-olled trial[J]. Surg Endosc， 2012， 26(3)：639-649.
7. Gong K， Zhang N， Lu Y， et al. Comparison of the open tension-free mesh-plug， transabdominal preperitoneal (TAPP)， and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial[J]. Surg Endosc， 2011， 25(1)：234-239.
8. Hamza Y， Gabr E， Hammadi H， et al. Four-arm randomized trial comparing laparoscopic and open hernia repairs[J]. Int J Surg， 2010， 8(1)：25-28.
9. 毛志海，李健文，王明亮，等. 两种不同腔镜腹股沟疝修补术CO_2充气对血流动力学与呼吸功能的影响[J]. 外科理论与实践， 2008， 13(3)：223-226.
10. Pokorny H， Klingler A， Schmid T， et al. Recurrence and compli-cations after laparoscopic versus open inguinal hernia repair：results of a prospective randomized multicenter trial[J]. Hernia， 2008， 12(4)：385-389.
11. Günal O， Ozer S， Gürleyik E， et al. Does the approach to the groin make a difference in hernia repair?[J]. Hernia， 2007， 11(5)：429-434.
12. Schrenk P， Woisetschläger R， Rieger R， et al. Prospective rand-omized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal， total preperitoneal or Shouldice technique for inguinal hernia repair[J]. Br J Surg， 1996， 83(11)：1563-1566.
13. Edwards CC 2nd， Bailey RW. Laparoscopic hernia repair：the learning curve[J]. Surg Laparosc Endosc Percutan Tech， 2000， 10(3)：149-153.
14. Dulucq JL， Wintringer P， Mahajna A. Laparoscopic totallyextraperitoneal inguinal hernia repair：lessons learned from 3 100 hernia repairs over 15 years[J]. Surg Endosc， 2009， 23(3)：482-486.
15. 刘伟红，杨彪，徐静. 腹腔镜腹股沟疝修补术网片钉合技术与免钉合技术疗效比较的系统评价[J]. 第二军医大学学报， 2010， 31(12)：1337-1340.
16. Lau H， Patil NG. Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty：multivariate analysis of predictive factors[J]. Surg Endosc， 2004， 18(1)：92-96.
17. Neumayer L， Fitzgibbons R Jr， Itani K， et al. Laparoscopic inguinal hernia repair[J]. J Am Coll Surg， 2005， 201(3)：486-487.
18. Phillips EH， Rosenthal R， Fallas M， et al. Reasons for earlyrecurrence following laparoscopic hernioplasty[J]. Surg Endosc，.
19. Sayad P， Hallak A， Ferzli G. Laparoscopic herniorrhaphy：reviewof complications and recurrence[J]. J Laparoendosc Adv Surg Tech A， 1998， 8(1)：3-10.
20. Lepere M， Benchetrit S， Debaert M， et al. A multicentric comparison of transabdominal versus totally extraperitoneal laparoscopic hernia repair using PARIETEX meshes[J]. JSLS， 2000， 4(2)：147-153.
21. Lau H， Patil NG， Yuen WK， et al. Urinary retention following endoscopic totally extraperitoneal inguinal hernioplasty[J]. Surg Endosc， 2002， 16(11)：1547-1550.
22. Hussain A， Nicholls J， El-Hasani S. Technical tips following more than 2 000 transabdominal preperitoneal (TAPP) repair of the groin hernia[J]. Surg Laparosc Endosc Percutan Tech， 2010， 20(6)：384-388.
23. ， 9(2)：140-145.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic Transabdominal Preperitoneal Versus Totally Extraperitoneal Approach of Inguinal Hernia Repair：A Meta Analysis

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