Comment on: Total extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review by updated traditional and cumulative meta-analysis of randomized-controlled trials

Excerpt

We were very interested to read the meta-analysis of randomized-controlled trials comparing total extraperitoneal endoscopic hernioplasty (TEP) versus open Lichtenstein hernioplasty by Gavriilidis et al. [1]. The authors came to the conclusion that the meta-analysis, which is based on randomized-controlled trials (RCTs) of high quality, showed significantly higher rates of recurrences and vascular injuries in the TEP cohort than in the Lichtenstein cohort. Since 2012 three other meta-analyses have been published on this topic and they, too, found a higher recurrence rate for TEP [2‐4]. The meta-analysis by Gavriilidis et al. [1] comparing the recurrence rates with previously published meta-analyses featured only one additional RCT from Sweden [5], which meant that now a total of 14 RCTs with 2678 TEP repairs and 2790 Lichtenstein repairs were available for comparison of the recurrence rates. Here, the recurrence rate for TEP was n = 149/2678 (5.6%) and for the Lichtenstein operation it was n = 99/2790 (3.5%) (p = 0.0005) [1]. Without the two largest studies, the remaining 12 of 14 RCTs comparing the recurrence rates identified a higher overall rate of n = 43/1091 (3.9%) for the Lichtenstein operation versus n = 28/1024 (2.7%) for TEP. …