title: TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia.
abstract: BACKGROUND
  More than 20 years since the introduction of TAPP and TEP into clinical routine, there is a lack of clarity due to conflicting comparative data. Therefore, more results from registries are needed.
  
  
  METHODS
  A total of 17,587 patients were enrolled prospectively between September 1, 2009, and April 15, 2013, in the Herniamed registry. Of these patients, 10,887 (61.9%) had a TAPP and 6700 (38.1%) a TEP repair. The dependent variables were intra- and postoperative complication rates, number of reoperations as well as absolute and relative frequencies. The results of unadjusted analyses were verified via multivariable analyses.
  
  
  RESULTS
  Multivariable analysis verified the results of unadjusted analysis, indicating that the surgical technique did not have any significant impact, also while taking account of other factors, on occurrence of intraoperative [p = 0.1648; OR = 1.214 (0.923; 1.596)] and general postoperative complications [p = 0.0738; OR = 1.315 (0.974; 1.775)]. Postoperative surgical complications [OR = 2.323 (1.882; 2.866); p < 0.0001] were noted more often after TAPP. Furthermore, the hernia defect size [p < 0.0001; I vs III: OR = 0.439 (0.313; 0.615), II vs III: OR = 0.712 (0.582; 0.872)] or scrotal [p < 0.0001; OR = 2.170 (1.501; 3.137)] hernia and age [p = 0.0002; 10-year OR = 1.135 (1.062; 1.213)] had a significant impact on the occurrence of postoperative complications. Complications were observed more commonly for larger hernia defects and a scrotal hernia. However, the difference in the postoperative complication rate between TEP and TAPP did not result in any difference in the reoperation rate (TEP 0.82% vs TAPP 0.90%; p = 0.6165).
  
  
  CONCLUSIONS
  The intraoperative and general postoperative complication rates as well as the reoperation rate for complications show no significant difference between TEP and TAPP. The higher postoperative complication rate for TAPP, which could be managed conservatively, is partly explained by larger defect sizes, more scrotal hernias and older age.
authors: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
authors: F
authors: F
authors: Köckerling
authors: Hernia Center, Winghofer Medicum, Winghofer Straße 42, 72108, Rottenburg am Neckar, Germany.
authors: R
authors: R
authors: Bittner
authors: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
authors: D A
authors: DA
authors: Jacob
authors: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
authors: L
authors: L
authors: Seidelmann
authors: StatConsult GmbH, Halberstädter Straße 40 a, 39112, Magdeburg, Germany.
authors: T
authors: T
authors: Keller
authors: StatConsult GmbH, Halberstädter Straße 40 a, 39112, Magdeburg, Germany.
authors: D
authors: D
authors: Adolf
authors: Department of General and Visceral Surgery, Diakonie Hospital, Rosenbergstraße 38, 70176, Stuttgart, Germany.
authors: B
authors: B
authors: Kraft
authors: Department of General and Visceral Surgery, German Red Cross Hospital, Lützerodestraße 1, 30161, Hannover, Germany.
authors: A
authors: A
authors: Kuthe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
keywords: Inguinal hernia repair; Intraoperative complications; Postoperative complications; Seroma; TAPP; TEP