Evidence - Transabdominal preperitoneal patch (TAPP) repair of inguinal hernia

Compared to the open Lichtenstein repair of (unilateral and bilateral) inguinal hernia in adults, the following differences have been reported for the TAPP procedure:

• Slightly lower recurrence rates (↑↑ [5; 10; 13; 23])
• Usually, somewhat longer operating times (↑↑ [6; 11; 13; 15; 19; 22])
• About the same postoperative pain situation (↑↑ [6; 11; 17; 19; 21; 22; 24; 27]), somewhat less often chronic pain (↑↑ [7; 10; 20; 23])
• Speedier recovery (↑↑ [2; 6; 11-15; 19; 21; 22; 27])
• Generally higher cost of hospitalization, but presumably lower economic costs overall (↑↑ [2; 4; 12; 13; 20; 27])

Compared with the Shouldice procedure the following effects have been verified:

• Slightly lower rate of inguinal hernia recurrence (↑↑ [1; 3; 5; 14; 18; 26])
• Usually, somewhat longer operating times (↑↑ [3; 26])
• Slightly less postoperative pain (↑↑ [3; 14; 26])
• Speedier recovery (↑↑ [3; 6; 14; 26])
• Somewhat less often nerve lesions and chronic pain (↑ [5; 16])

Compared with the totally extraperitoneal procedure (TEP), the current data for the TAPP confirm the following:

• Somewhat shorter operating time (↑↑ [4; 6; 8])
• Similar pain intensity and recurrence rate

One trial comparing stapled mesh fixation with no mesh fixation found the following for TAPP:

• Comparable recurrence rates (↑ 25)
• Similar rates of chronic pain (↑ 25)

QOL in Incarcerated Inguinal Hernias: TAPP Vs Open Repair

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13. Johansson B, Hallerbäck B, Glise H, Anesten B, Smedberg S, Román J. Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study). Ann Surg 1999; 230: 225-31.
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15. Khoury N. A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: a study of 315 cases. J Laparoendosc Adv Surg Tech A 1998; 8: 367-72.
16. Köninger J, Redecke J, Butters M. Chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP. Langenbecks Arch Surg 2004; 389: 361-5.
17. Köninger JS, Oster M, Butters M. Leistenhernienversorgung – ein Vergleich gängiger Verfahren. Chirurg 1998; 69: 1340-4.
18. Leibl BJ, Däubler P, Schmedt CG, Kraft K, Bittner R. Long-term results of a randomized clinical trial between laparoscopic hernioplasty and Shouldice repair. Br J Surg 2000; 87: 780-3.
19. Mahon D, Decadt B, Rhodes M. Prospective randomized trial of laparoscopic (transabdominal preperitoneal) vs open (mesh) repair for bilateral and recurrent inguinal hernia. Surg Endosc 2003; 17: 1386-90.
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21. Paganini AM, Lezoche E, Carle F, Carlei F, Favretti F, Feliciotti F, Gesuita R, Guerrieri M, Lomanto D, Nardovino M, Panti M, Ribichini P, Sarli L, Sottili M, Tamburini A, Taschieri A. A randomized, controlled, clinical study of laparoscopic vs open tension-free inguinal hernia repair. Surg Endosc 1998; 12: 979-86.
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24. Schrenk P, Woisetschläger R, Rieger R, Wayand W. Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair. Br J Surg 1996; 83: 1563-6.
25. Smith AI, Royston CM, Sedman PC. Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. A prospective randomized trial. Surg Endosc 1999; 13: 804-6.
26. Tschudi JF, Wagner M, Klaiber C, Brugger JJ, Frei E, Krähenbühl L, Inderbitzi R, Boinski J, Hsu Schmitz SF, Hüsler J. Randomized controlled trial of laparoscopic transabdominal preperitoneal hernioplasty vs Shouldice repair. Surg Endosc 2001; 15: 1263-6.
27. Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, Singh R, Spiegelhalter D. Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. BMJ 1998; 317: 103-10.