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

  1. Literature summary

    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)
  2. Ongoing trials on this topic

  3. References on this topic

    1. Arvidsson D, Berndsen FH, Larsson LG, Leijonmarck CE, Rimback G, Rudberg C, Smedberg S, Spangen L, Montgomery A. Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg 2005; 92: 1085-91
    2. Beets GL, Dirksen CD, Go PMNYH, Geisler FEA, Baeten CGMI, Kootstra G. Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial. Surg Endosc 1999; 13: 323-7.
    3. Berndsen FH, Petersson U, Arvidsson D, Leijonmarck CE, Rudberg C, Smedberg S, Montgomery A. Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group. Hernia 2007; 11: 307-13.
    4. Butler RE, Burke R, Schneider JJ, Brar H, Lucha PA, Jr. The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded, prospective, randomized trial. Surg Endosc 2007; 21: 387-90.
    5. Butters M, Redecke J, Koninger J. Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs. Br J Surg 2007; 94: 562-5.
    6. Dedemadi G, Sgourakis G, Karaliotas C, Christofides T, Kouraklis G, Karaliotas C. Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study. Surg Endosc 2006; 20: 1099-104.
    7. Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM. Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. BMJ 2003; 326: 1012-3.
    8. Fitzgibbons RJ, Jr., Camps J, Cornet DA, Nguyen NX, Litke BS, Annibali R, Salerno GM. Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial. Ann Surg 1995; 221: 3-13.
    9. Günal O, Ozer S, Gürleyik E, Bahcebasi T. Does the approach to the groin make a difference in hernia repair? Hernia 2007; 11: 429-34.
    10. Heikkinen T, Bringman S, Ohtonen P, Kunelius P, Haukipuro K, Hulkko A. Five-year outcome of laparoscopic and Lichtenstein hernioplasties. Surg Endosc 2004; 18: 518-22.
    11. Heikkinen TJ, Haukipuro K, Hulkko A. A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit. A randomized prospective study. Surg Endosc 1998; 12: 1199-203.
    12. Heikkinen TJ, Haukipuro K, Koivukangas P, Hulkko A. A prospective randomized outcome and cost comparison of totally extraperitoneal endoscopic hernioplasty versus Lichtenstein hernia operation among employed patients. Surg Laparosc Endosc 1998; 8: 338-44.
    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.
    14. Juul P, Christensen K. Randomized clinical trial of laparoscopic versus open inguinal hernia repair. Br J Surg 1999; 86: 316-9.
    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.
    20. McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 2005; 9: 1-203, iii-iv.
    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.
    22. Picchio M, Lombardi A, Zolovkins A, Mihelsons M, La Torre G. Tension-free laparoscopic and open hernia repair: randomized controlled trial of early results. World J Surg 1999; 23: 1004-9.
    23. Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 2005; 19: 188-99.
    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.

1. Köckerling F, Schug-Pass C. Tailored approach in inguinal hernia repair – decision tree based on

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