title: Totally extraperitoneal laparoscopic hernioplasty versus open extraperitoneal approach for inguinal hernia repair: a meta-analysis of outcomes of our current knowledge.
abstract: BACKGROUND
  The aim of this article is to explore the clinical effects between open extraperitoneal approaches and totally extraperitoneal laparoscopic hernioplasty (TEP) in the repair of inguinal hernias.
  
  
  METHODS
  The electronic databases Pubmed, Medline, Embase, Web of science and the Cochrane Library were used to search for articles from January 1992 to March 2013. The present meta-analysis pooled the effects of outcomes of a total of 1157 patients with 1377 hernias enrolled into 10 randomized controlled trials and 2 comparative studies. The data was analyzed using the statistic software Stata12.0 and IBM SPSS Statistics 19.
  
  
  RESULTS
  Significant advantages of totally extraperitoneal laparoscopic hernioplasty (TEP) compared to the open extraperitoneal approach include a lower incidence of total postoperative complications (Odds Ratio, 0.544; 95% confidence interval, 0.369-0.803), a reduction in urinary problems (0.206[0.064,0.665]), an earlier return to normal activities or work (SMD = -1.798[-3.322,-0.275]), and a shorter length of hospital stay (-1.995 [-2.358,-1.632]). No difference was found in operative time, the incidence of hernia recurrence, chronic pain, intraoperative complications, seromas or hematomas, wound infection and testicular problems between the two techniques. One significant advantage for the open extraperitoneal inguinal hernia repair was a lower incidence of peritoneal tears (46.504 [15.399,140.437]).
  
  
  CONCLUSIONS
  Totally extraperitoneal laparoscopic hernioplasty (TEP) and open extraperitoneal mesh repair are equivalent in most of the analyzed outcomes. TEP is associated with shorter hospital stay, quicker return to normal activities or work, lower incidence of total postoperative complications and urinary problems, while the open extraperitoneal method has less incidence of peritoneal tears.
authors: Department of General Surgery, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, 210000 Nanjing, Jiangsu, China.
authors: Xiang
authors: X
authors: Zhu
authors: Department of General Surgery, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, 210000 Nanjing, Jiangsu, China. Electronic address: 421778579@qq.com.
authors: Hongyong
authors: H
authors: Cao
authors: Department of General Surgery, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, 210000 Nanjing, Jiangsu, China.
authors: Yong
authors: Y
authors: Ma
authors: Department of General Surgery, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, 210000 Nanjing, Jiangsu, China.
authors: Aihua
authors: A
authors: Yuan
authors: Department of General Surgery, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, 210000 Nanjing, Jiangsu, China.
authors: Xiangyang
authors: X
authors: Wu
authors: Department of General Surgery, The People's Hospital of Jiangsu Province, Affiliated to Nanjing Medical University, 210000 Nanjing, Jiangsu, China.
authors: Yi
authors: Y
authors: Miao
authors: Department of General Surgery, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, 210000 Nanjing, Jiangsu, China.
authors: Song
authors: S
authors: Guo
mesh_terms: D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D010537:Peritoneum; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Hernioplasty; Inguinal hernia; Meta-analysis; Open extraperitoneal approach; Randomized controlled trials; TEP