Transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) repair for inguinal hernia: a systematic review and meta-analysis

INTRODUCTION: Laparoscopic inguinal hernia repair is widely adopted due to reduced postoperative pain and faster recovery. The two main minimally invasive approaches - transabdominal preperitoneal repair (TAPP) and totally extraperitoneal repair (TEP) - differ in anatomical access and technique. This meta-analysis compares their perioperative and postoperative outcomes. METHODS: Following PRISMA guidelines, we included randomised controlled trials and comparative cohorts of adults undergoing TAPP or TEP. Outcomes extracted included operative time, pain, hospital stay and complications. Meta-analysis was performed using RevMan version 5.4, with heterogeneity guiding model selection. FINDINGS: Seven studies including 986 patients (TAPP 533; TEP 453) were analysed. Operative time did not differ significantly (mean difference (MD) 8.63min, 95% confidence interval (CI) -11.71 to 28.96), despite variability across studies. Hospital stay was similar (MD -0.51h, 95% CI -1.82 to 0.79). Early postoperative pain at 1, 6 and 24h showed no significant differences, although heterogeneity was high. Wound infections were rare and comparable (risk ratio (RR) 2.02, 95% CI 0.62-6.57). TAPP was associated with significantly fewer seromas (RR 0.67, 95% CI 0.52-0.88) but higher rates of scrotal oedema (RR 1.42, 95% CI 1.02-1.98). Subgroup analyses suggested heterogeneity in operative time may reflect surgeon experience and technique, while consistent hospital stay patterns indicate similar recovery. Overall, both approaches showed comparable perioperative outcomes, with distinct complication profiles that may inform individualised surgical decision-making. CONCLUSIONS: TAPP and TEP demonstrate similar operative time, early pain and hospital stay. TAPP reduces seroma risk, while TEP has lower scrotal oedema rates. Both are safe and effective, with choice guided by patient factors and surgeon expertise.