Comparison of Outcomes of Total Extraperitoneal Repair and Transabdominal Preperitoneal Approach in Inguinal Hernia Surgery

Objective: This study compares the outcomes of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques in inguinal hernia repair, focusing on the relationship between the number of tacks used for mesh fixation and the incidence of chronic postoperative pain.Despite advancements in minimally invasive surgery, chronic pain remains a significant complication.Methods: This retrospective study analyzes retrospectively collected data from patients who underwent elective laparoscopic inguinal hernia repair (TEP or TAPP) between 2019 and 2023.It compares early and late postoperative complications, examining the relationship between the number of tacks used for mesh fixation and chronic pain or recurrence.Results: This study includes 164 patients who underwent TEP (n=117) or TAPP (n=47) for inguinal hernia repair.No significant differencec in chronic pain and recurrence rates between the groups were detected.TAPP patients had larger hernias (p=0.024), had more frequent recurrent operations (p=0.042), and higher seroma rates (p=0.003).Operative times and tack numbers were greater in TAPP (p=0.086,p<0.001).American Society of Anesthesiologists class 3, presence of recurrence, and early hematoma were associated with recurrence.Chronic pain correlated with the number of tacks used for mesh fixation (p=0.001) but not with seroma or hematoma (p=0.313,p=0.578).Recurrence rates were similar between groups (p=0.228).The number of tacks used was identified as an independent risk factor for chronic pain in the multivariate analysis (p=0.001, odds ratio: 5,103, %95 confidence intervals: 2,093-12,446). Conclusion:Comparisons between TEP and TAPP techniques have shown similar outcomes in terms of intraoperative and postoperative complications.Reducing the number of mechanical fixations may help decrease the incidence of chronic pain.