title: Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial.
abstract: BACKGROUND
  Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the "best groin hernia repair." The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair.
  
  
  METHODS
  The present prospective randomized study was conducted between May 2007 and March, 2009 and included 100 patients suffering from uncomplicated primary groin hernia. Patients were randomized into group I (TEP) and group II (TAPP). Intraoperative variables and postoperative pain scores were recorded in a prestructured form.
  
  
  RESULTS
  One hundred patients were included in the study (TEP, 53; TAPP, 47). Both groups were comparable in terms of demographic profile and hernia characteristics. The average operative time was higher in the TAPP group (p = 0.209). The pain scores at 1 h and 24 h after surgery and at 3-month follow-up were significantly higher in the TAPP group (p < 0.05). The average follow-up was 30.5 months. In the TEP group, 37.8% of patients had seroma compared to 18.3% in the TAPP group (p = 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (16 vs. 9, p = 0.009). The wound infection rates were equal (2% vs. 3%). There has been no recurrence in either group during the follow-up period of 44 months. Overall, the patients were more satisfied with TEP rather than TAPP (p < 0.05).
  
  
  CONCLUSIONS
  In the present study, TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Asuri
authors.initials: A
authors.lastname: Krishna
authors.forename: M C
authors.initials: MC
authors.lastname: Misra
authors.forename: Virinder Kumar
authors.initials: VK
authors.lastname: Bansal
authors.forename: Subodh
authors.initials: S
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Rajeshwari
authors.forename: Anjolie
authors.initials: A
authors.lastname: Chabra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004438:Ecchymosis / Q000209:etiology; D005260:Female; D006552:Hernia, Inguinal / Q000191:economics / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D049291:Seroma / Q000209:etiology; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology; D055815:Young Adult