Comparison of long-term outcomes of different methods of laparoscopic inguinal hernia repair (TAPP and TEP)

Background. There are two main techniques for laparoscopic inguinal hernia repair — transabdominal preperitoneal repair (TAPP) and total extraperitoneal repair (TEP). Both methods have been compared with each other multiple times, however, neither one nor the other method has demonstrated a clear advantage. Objective. To compare the outcomes of TAPP and TEP, including long-term results — the development of recurrence and chronic pain syndrome. Material and methods. A retrospective cohort observational study was conducted involving patients who underwent laparoscopic inguinal hernia repair (TAPP or TEP) in 2019. In 2023, a telephone survey of patients was conducted, the main purpose of which was to compare the incidence of recurrences and chronic pain. All patients who presented with any complaints were invited for examination and ultrasound of the groin areas. Results. TAPP was more often performed in patients with indirect hernias and hernias with a hernia size of more than 1.5 cm (size 2 and 3 according to the classification of the European Hernia Society), while TEP technology was more often used in patients with a direct hernia and hernias with a hernia size of up to 1.5 cm (size 1 according to the EHS classification). Comparing the duration of the surgical operation, it was found that TAPP, on average, took longer than TEP (70 vs 55 minutes, p<0.001), and fixation was more often used with TAPP. There was no statistically significant difference between the groups regarding the incidence of recurrence and chronic pain. Given the incomparability of the groups in terms of size and location of the hernia defect, propensity match score analysis was conducted. After that there was also no statistically significant difference in the incidence of recurrence and chronic pain between the groups of patients who underwent TAPP and TEP. Conclusion. When assessing both the total number of complications and long-term results, both methods did not demonstrate statistically significant differences from each other and can be recommended for widespread use.