Our Summary

An inguinal hernia is when part of the intestine pushes through the abdominal muscles. It’s a common condition in adults, especially men. If it gets worse or doesn’t improve, surgery is usually needed. There are two types of keyhole surgeries used to repair this type of hernia: transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). Both use a mesh to reinforce the abdominal wall, but they differ in their approach. TAPP goes through the abdominal cavity, while TEP avoids it, working outside the lining of the abdominal wall.

There’s ongoing debate about which method is better. TEP avoids entering the abdominal cavity but is harder for surgeons to learn. TAPP is simpler and allows for inspection of the opposite side, but may carry a higher risk of injury.

This review compares the benefits and risks of the two methods. The authors looked at 23 studies involving 2,266 people, mostly men, needing hernia repair. The results suggest there might be little to no difference between TAPP and TEP in terms of serious side effects, hernia recurrence, or chronic pain. But the evidence was not very certain, so more research is needed.

One difference they did find was that TEP might be more likely to need to be converted to another method (either TAPP or open surgery). This means if surgeons choose TEP as their standard method, they should have a plan if they need to switch to another technique.

Ultimately, the choice between TAPP and TEP should involve a discussion between surgeons and patients, considering both their preferences. Future studies should focus on patient-reported outcomes, like quality of life after surgery.

FAQs

  1. What is an inguinal hernia and how is it treated?
  2. What are the differences between TAPP and TEP methods in laparoscopic hernia repair?
  3. What are the potential risks and benefits of TAPP and TEP hernia repair methods?

Doctor’s Tip

A helpful tip a doctor might give a patient about laparoscopic hernia repair is to discuss with your surgeon the benefits and risks of both TAPP and TEP approaches. It’s important to understand the differences between the two methods and how they may impact your recovery and long-term outcomes. Additionally, make sure to follow your surgeon’s post-operative instructions carefully to ensure a successful recovery.

Suitable For

Patients who are typically recommended for laparoscopic hernia repair are those with inguinal hernias that are causing symptoms, such as pain or discomfort, and have not improved with conservative treatment. This procedure is commonly recommended for adult men, but can also be done in women. The choice between TAPP and TEP should be made based on individual factors, such as the surgeon’s experience and the patient’s preferences.

Timeline

Before laparoscopic hernia repair, a patient may experience symptoms such as a bulge or swelling in the groin area, discomfort or pain, especially when lifting heavy objects or straining, and a dragging sensation in the groin. They may also have difficulty performing daily activities or exercising.

After laparoscopic hernia repair, the patient will typically have a faster recovery time compared to traditional open surgery. They may experience some pain and discomfort at the incision sites, but this can usually be managed with pain medication. Patients are usually able to resume normal activities within a few days to a week after surgery, depending on their individual recovery.

Overall, laparoscopic hernia repair is a safe and effective option for treating inguinal hernias, with minimal scarring and a lower risk of complications compared to open surgery. Patients should follow their surgeon’s post-operative instructions, attend follow-up appointments, and contact their healthcare provider if they experience any unusual symptoms or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laparoscopic hernia repair include:

  1. What are the benefits and risks of TAPP versus TEP for my specific hernia repair?
  2. How experienced are you in performing both TAPP and TEP procedures?
  3. What is the success rate of each procedure in terms of hernia recurrence?
  4. What is the likelihood of experiencing chronic pain after each type of surgery?
  5. Are there any specific factors about my hernia that make one procedure more suitable than the other?
  6. What does the recovery process look like for each method, and how long can I expect to be out of work or restricted in my activities?
  7. What are the potential complications of each procedure, and how are they typically managed?
  8. How likely is it that my surgery may need to be converted to a different method during the procedure?
  9. Will I need to follow any specific post-operative care instructions or attend follow-up appointments after surgery?
  10. Are there any alternative treatment options to consider besides laparoscopic hernia repair?

Reference

Authors: Andresen K, Rosenberg J. Journal: Cochrane Database Syst Rev. 2024 Jul 4;7(7):CD004703. doi: 10.1002/14651858.CD004703.pub3. PMID: 38963034