A randomised controlled study to compare the extended view totally extraperitoneal and transabdominal pre-peritoneal in terms of early post-operative complications in groin hernias

INTRODUCTION: The extended-view totally extraperitoneal (eTEP) technique is designed to overcome the limited working space and fixed port constraints of conventional totally extraperitoneal (TEP) hernia repair. This study aimed to provide a direct, randomised comparison of early outcomes between the eTEP approach and the transabdominal pre-peritoneal (TAPP) technique for groin hernias. PATIENTS AND METHODS: A prospective, randomised, single-blind, parallel-group trial was conducted at a tertiary care centre. Seventy patients were allocated to either eTEP or TAPP repair (35 per group). Early post-operative complications - defined as post-operative pain, seroma and scrotal hematoma - were assessed as the primary composite endpoint. Key secondary endpoints included operative time, intraoperative complications, blood loss, hospital stay and early recurrence. RESULTS: Demographic and hernia characteristics were comparable at baseline. While Visual Analogue Scale pain scores decreased significantly over time in both groups ( P < 0.001), there was no statistically significant difference between the groups at any assessed interval. Seroma was clinically detected in three patients (8.6%) in the eTEP group at 1 week, all of which resolved spontaneously; no seromas occurred in the TAPP group ( P = 0.239). The median operative time was significantly shorter for eTEP (85 min, interquartile range [IQR]: 76-103) compared to TAPP (94 min, IQR: 87-110; P = 0.011). Rates of intraoperative complications, blood loss and mean hospital stay were similar between groups. CONCLUSION: Both eTEP and TAPP are safe and effective for groin hernia repair, demonstrating comparable early post-operative pain and morbidity. The eTEP technique was associated with a statistically significant reduction in operative time, positioning it as a valuable surgical alternative to TAPP. TRIAL REGISTRATION: Clinical Trials Registry-India (CTRI/2023/09/057520).