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Surgical Endoscopy

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Open Access 01-12-2015

TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia

Authors: F. Köckerling, R. Bittner, D. A. Jacob, L. Seidelmann, T. Keller, D. Adolf, B. Kraft, A. Kuthe

Published in: Surgical Endoscopy | Issue 12/2015

Abstract

Introduction

More than 20 years since the introduction of TAPP and TEP into clinical routine, there is a lack of clarity due to conflicting comparative data. Therefore, more results from registries are needed.

Patients and methods

A total of 17,587 patients were enrolled prospectively between September 1, 2009, and April 15, 2013, in the Herniamed registry. Of these patients, 10,887 (61.9 %) had a TAPP and 6700 (38.1 %) a TEP repair. The dependent variables were intra- and postoperative complication rates, number of reoperations as well as absolute and relative frequencies. The results of unadjusted analyses were verified via multivariable analyses.

Results

Multivariable analysis verified the results of unadjusted analysis, indicating that the surgical technique did not have any significant impact, also while taking account of other factors, on occurrence of intraoperative [p = 0.1648; OR = 1.214 (0.923; 1.596)] and general postoperative complications [p = 0.0738; OR = 1.315 (0.974; 1.775)]. Postoperative surgical complications [OR = 2.323 (1.882; 2.866); p < 0.0001] were noted more often after TAPP. Furthermore, the hernia defect size [p < 0.0001; I vs III: OR = 0.439 (0.313; 0.615), II vs III: OR = 0.712 (0.582; 0.872)] or scrotal [p < 0.0001; OR = 2.170 (1.501; 3.137)] hernia and age [p = 0.0002; 10-year OR = 1.135 (1.062; 1.213)] had a significant impact on the occurrence of postoperative complications. Complications were observed more commonly for larger hernia defects and a scrotal hernia. However, the difference in the postoperative complication rate between TEP and TAPP did not result in any difference in the reoperation rate (TEP 0.82 % vs TAPP 0.90 %; p = 0.6165).

Conclusion

The intraoperative and general postoperative complication rates as well as the reoperation rate for complications show no significant difference between TEP and TAPP. The higher postoperative complication rate for TAPP, which could be managed conservatively, is partly explained by larger defect sizes, more scrotal hernias and older age.

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Tetik C, Arregui ME, Dulucq JL, Fitzgibbons RJ, Franklin ME, McKernan JB, Rosin RD, Schultz LS, Toy FK (1994) Complications and recurrences associated with laparoscopic repair of groin hernias. A multi-institutional retrospective analysis. Surg Endosc 8(11):1316–1322CrossRefPubMed

McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A (2005) Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 9:109–114CrossRefPubMed

O´Reilly EA, Burke JP, O`Connell PR (2012) A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia. Ann Surg 255:846–853CrossRef

Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, Pecchia L (2012) Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? a systematic review of the literature with a network meta-analysis. Surg Endosc 26:3355–3366CrossRefPubMed

Antoniou SA, Antoniou GA, Bartsch DK, Fendrich V, Koch OO, Pointner R, Granderath FA (2013) Transabdominal preperitoneal versus totally extraperitoneal repair of inguinal hernia: a meta-analysis of randomized studies. Am J Surg 206:245–252CrossRefPubMed

Schrenk P, Woisetschläger R, Rieger R, Wayand W (1996) Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair. Br J Surg 83:1563–1566CrossRefPubMed

Heikkinen T, Bringman S, Ohtonen P, Kunelius P, Haukipuro K, Hulkko A (2004) Five-year outcome of laparoscopic and Lichtenstein hernioplasties. Surg Endosc 18(3):518–522CrossRefPubMed

Dedemadi G, Sgourakis G, Karaliotas C, Christofides T, Kouraklis G, Karaliotas C (2006) Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study. Surg Endosc 20:1099–1104CrossRefPubMed

Butler RE, Burke R, Schneider JJ, Brar H, Lucha PA Jr (2007) The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded, prospective, randomized trial. Surg Endosc 21:387–390CrossRefPubMed

10.

Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, Steiner E, Pernthaler H, Függer R, Scheyer M (2008) Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 12:385–389CrossRefPubMed

11.

Zhu Q, Mao Z, Yu B, Jin J, Zheng M, Li J (2009) Effects of persistent CO(2) insufflation during different laparoacopic inguinal hernioplasty: a prospective, randomized, controlled study. J Laparoendosc Adv Surg Tech A 19(5):611–614CrossRefPubMed

12.

Hamza Y, Gabr E, Hammadi H, Khalil R (2010) Four-arm randomized trial comparing laparoscopic and open hernia repairs. Int J Surg 8:25–28CrossRefPubMed

13.

Gong K, Zhang N, Lu Y, Zhu B, Zhang Z, Du D, Zhao X, Jiang H (2011) Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc 25:234–239CrossRefPubMed

14.

Günal O, Ozer S, Gürleyik E, Bahebasi T (2007) Does he approach to the groin make a difference in hernia repair? Hernia 11:429–434CrossRefPubMed

15.

Krishna A, Misra MC, Bansal VK, Kumar S, Rajeshwari S, Chabra A (2012) Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 26:639–649CrossRefPubMed

16.

Gass M, Banz VM, Rosella L, Adamina M, Candinas D, Güller U (2012) TAPP or TEP? population-based analysis of prospective data on 4,552 patients undergoing endoscopic inguinal hernia repair. World J Surg 36:2782–2786CrossRefPubMed

17.

Wittenbecher F, Scheller-Kreinsen D, Röttger J, Busse R (2013) Comparison of hospital costs and lenght of stay associated with open-mesh, totally extraperitoneal inguinal hernia repair, and transabdominal preperitoneal inguinal hernia repair: an analysis of observational data using propensity score matching. Surg Endosc 27(4):1326–1333CrossRefPubMed

18.

Felix EL, Michas CA, Gonzales MH Jr (1995) Laparoscopic hernioplasty TAPP vs. TEP. Surg Endosc 9:984–989PubMed

19.

Ramshaw BJ, Tucker JG, Conner T, Mason EM, Duncan TD, Lucas GW (1996) A comparison of the approaches to laparoscopic herniorraphy. Surg Endosc 10(1):29–32CrossRefPubMed

20.

Cohen RV, Alvarez G, Roll S, Garcia ME, Kawahara N, Schiavon CA, Schaffa TD, Pereira PR, Margarido NF, Rodrigues AJ (1998) Transabdominal or totally extraperitoneal laparoscopic hernia repair. Surg Laparosc Endosc 8(4):264–268CrossRefPubMed

21.

Czechowski A, Schafmayer A (2003) TAPP vs. TEP. Chirurg 74:1143–1148CrossRefPubMed

22.

Belyansky I, Tsirline VB, Klima DA, Walters AL, Lincourt AE, Heniford TB (2011) Prospective, comparative study of postoperative quality of life in TEP, TAPP, and modified Lichtenstein repairs. Ann Surg 254(5):709–714CrossRefPubMed

23.

Shah NR, Mikami DJ, Cook C, Manilchuk A, Hodges C, Memark VR, Volckmann ET, Hall CR, Steinberg S, Needleman B, Hazey JW, Melvin WS, Narula VK (2011) A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias. Surg Endosc 25:2330–2337CrossRefPubMed

24.

Zanghì A, Di Vita M, Lo Menzo E, Castorina S, Cavallaro AS, Piccolo G, Grosso G, Cappellani A (2011) Multicentric evaluation by Verbal Rate Scale and EuroQoL-5D of early and late post-operative pain after TAPP and TEP procedures with mechanical fixation for bilateral inguinal hernias. Ann Ital Chir 82(6):437–442PubMed

25.

Stechemesser B, Jacob DA, Schug-Paß C, Köckerling F (2012) Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16(3):269–276. doi:10.1007/s10029-012-0908-3 CrossRefPubMed

26.

Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403PubMedCentralCrossRefPubMed

27.

Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, Hoeferlin A, Kongsnorth AN, Mandala V, Palot JP, Schumpelick V, Simmermacher RK, Stoppa R, Flament JB (2007) The European hernia society groin hernia classification: simple and easy to remember. Hernia 11:113–116CrossRefPubMed

28.

Köckerling F, Schug-Pass C (2014) Tailored approach in inguinal hernia repair—decision tree based on the guidelines. Front Surg 1:20. doi:10.3389/fsurg.2014.00020 PubMedCentralPubMed

29.

Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Paß C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843PubMedCentralCrossRefPubMed

30.

Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Koeckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales Conde S, Reinpold W, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P (2014) Update of guidelines on laparoscopic (TAPP) and andonscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc. doi:10.1007/s00464-014-3917-8

Title: TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia
Authors: F. Köckerling
R. Bittner
D. A. Jacob
L. Seidelmann
T. Keller
D. Adolf
B. Kraft
A. Kuthe
Publication date: 01-12-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4150-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia

Abstract

Introduction

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

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