Comparison of laparoscopic TAPP and TEP

Background: Laparoscopic repair of inguinal hernias is performed nowadays either by transabdominal preperitoneal approach (TAPP) or by total extraperitoneal approach (TEP). Few trials had directly compared both of them.
Methods: We performed a randomized, prospective trial in which 80 male patients with primary unilateral inguinal hernia were treated laparoscopically. 40 patients were treated by transabdominal preperitoneal repair and the other 40 patients were treated by laparoscopic total extraperitoneal repair. We recorded information about preoperative data, operative details, operative time, intraoperative complications, postoperative recovery, postoperative complications, and long term follow–up. We examined the patients for follow-up one and six weeks, six months, and one year after surgery.
Results: Small intestinal injury occurred in 1 patient in TAPP group. Extraperitoneal bleeding occurred in 3 patients in each group. 4 patients in TAPP group were converted to open Lichtenstein repair. TEP procedure failed in 5 patients, 4 of them were converted to open repair. In the remaining patient, TEP procedure was converted to TAPP technique that was successfully performed without conversion to open repair. No major vessel, bladder or spermatic cord injury had occurred in any patient in either group. Operative time was slightly longer in TEP group. Hospital stay, recovery period, postoperative and chronic pain were nearly the same in both groups. After a 1 year follow up period, recurrence has been diagnosed in 2 patients; one in each group. No cases of port-site hernia, internal hernia or intestinal obstruction were reported in either group.
Conclusion: When performed correctly, both techniques can produce satisfactory results. The learning curve in TEP approach is longer, but it is safer to be performed as the abdominal cavity virginity is intact. TEP when efficiently experienced and mastered is the procedure of choice in laparoscopic repair of inguinal hernia. However, surgeons who choose TEP must know well how to do TAPP technique since conversion of TEP to TAPP is possible; otherwise conversion to open technique is mandatory.