Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review.
BACKGROUND
Although a large number of surgeons currently perform endoscopic hernia surgery using a total extraperitoneal (TEP) approach, reviews published to date are based mainly on trials that compare laparoscopic transabdominal preperitoneal (TAPP) repair with various types of open inguinal hernia repair.


METHODS
A qualitative analysis of randomized trials comparing TEP with open mesh or sutured repair.


RESULTS
In this review, 4,231 patients were included in 23 trials. In 10 of 15 trials, TEP repair was associated with longer surgery time than open repair. A shorter postoperative hospital stay after TEP repair than after open repair was reported in 6 of 11 trials. In 8 of 9 trials, the time until return to work was significantly shorter after TEP repair. Hospital costs were significantly higher for TEP than for open repair in all four trials that included an economic evaluation. Most trials (n = 14) reported no differences in subsequent recurrence rates between TEP and open repair.


CONCLUSIONS
The findings showed that endoscopic TEP repair is associated with longer surgery time, shorter postoperative hospital stay, earlier return to work, and recurrence rates similar to those for open inguinal hernia repair. The procedure involves greater expenses for hospitals, but appears to be cost effective from a societal perspective. The TEP technique is a serious option for mesh repair of primary hernias.
Kuhry
E
E
Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands. esther.kuhry@gmail.com
van Veen
R N
RN
Langeveld
H R
HR
Steyerberg
E W
EW
Jeekel
J
J
Bonjer
H J
HJ
D003362:Cost-Benefit Analysis; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome