Totally extraperitoneal versus transabdominal preperitoneal laparoscopic techniques for hernia inguinal repair using glue for mesh and peritoneal closure

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Radenko Koprivica Sanjanin Perišić Jelko Čopi Jernej Šadl


Background: Totally extraperitoneal (TEP) and transabdominal preperitoneal repair (TAPP) are standard techniques of laparoscopic approach of groin hernia repair. Many studies compare clinical efficacy between TEP and TAPP technique. Which is the best approach?  The choice of technique of hernia inguinal repair is still controversial.

Aim: To compare our result in last three years in laparoscopic hernia inguinal repair.

Material and methods: This study is retrospective-prospective analysis of patients database with TEP and TAPP hernia inguinal repair between January 2021 to September 2023. Patients demografic profile, hernia characteristic and clinical outcomes included in database. We performed two groups patients: TEP groups and TAPP groups. The primary endpoint included: mesh and peritoneum fixation, operative time, intra and postoperative complication, hospital stay and conversion rate. The secondary outcomes were recurrence rates, acute and chronic pain. The follow-up time was 12 months. The results were processed by the methods of classical statistic analysis. The significance level was 0,05.

Results:  A total of 278 patients divide into two groups: TEP group had 128 patients and TAPP group had 150. There were 255 men and 23 women. The average age is 52.67 years. The American Society of Anesthesiologists Physical Status Classification System (ASA) had ASA I 157, ASA II 105 and ASA III 16 patients. There were 138 right and 140 left inguinal hernias. Bilateral hernias were 110, unilateral 168. There were 20,14% (56) recurrent hernias after Lichtenstein hernioplasty. The size of the hernia measured according to the criteria of the European Hernia Society (EHS) was L1/M1 106 or 38,1 %, L2/M2 114 or 41 % and L3/M3 58 or 20,9 %. There was no statistically significant difference by groups for age, ASA classification, hernia size, and location. We fixed the mesh in 87,3% (216) with glue, in 11% (30) we gave a self-fixing mesh and in 11,7% (32) cases we did not fix the mesh. We used lightweight titanium mesh in 89 % of cases and self gripping mesh in 11%. There was no statistically significant difference between TEP and TAPP groups in the method of mesh fixation and mesh type. In the TAPP group, we closed the peritoneum in 50,7% (76) cases with glue, in 38,7% (58) it was sutured and in 10,6% (16) suturing and gluing was done. Operative time of unilateral hernia surgery in the TEP group is 42 min, in the TAPP 60 min. In bilateral hernia, the operation time of TEP group is 74 min, TAPP group 105 min. The difference was statistically significant between the groups in both cases (p <0.05). The time of hospitalization is the same in both groups and is one day. Intraoperative complications were similarly distributed in both groups, without statistical significance (hemorrhage TEP 4, TAPP group 4, peritoneal lacerations TEP 12, TAPP 10). There was two conversion (0,72%) to another type of operation in both groups (TEP 1, TAPP 1). Postoperatively, we had groin seroma  in 3,6 % (10) of cases (TEP group 5, TAPP 5), testicular hematoma in 3,6% (10) of patients (TEP 4, TAPP 6).  There were two ( 0,72%) reinterventions, the first after the TAPP procedure due to postoperative ileus, and the second after TEP procedure due to iatrogenic perforation of the urinary bladder. Acute pain up to 30 days after surgery in 3,24% (9) patients (TEP 4, TAPP 5). There was no statistically significant difference in the occurrence of these postoperative complications (p> 0.05). Chronic pain was present in TEP group 3 and in TAPP group 4 patients, a total of 7 or 2,52 %, with no statistically significant difference. Hernia recurrence was present in 5 patients or 1,8 %, without statistical difference by groups (TEP 2, TAPP 3) .

Conclusions: Both laparoscopic techniques have similar complication, acute and chronic pain and recurrence rates. Thery are in exelent technique of laparoscopic inguinal hernia repair with acceptable complications. TEP has the advantage that the peritoneal cavity is not breached. However is more difficult to master when compared with TAPP. In conclusion, the choice of the technique should be based on the surgeon”s skills, hospital practice, education and experience.

Keywords: Laparoscopic hernia inguinal repair, TEP, total extraperitoneal repair, TAPP, transabdominal preperitoneal repair, recurrent inguinal hernia, chronic pain

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KOPRIVICA, Radenko et al. Totally extraperitoneal versus transabdominal preperitoneal laparoscopic techniques for hernia inguinal repair using glue for mesh and peritoneal closure. Medical Research Archives, [S.l.], v. 12, n. 4, apr. 2024. ISSN 2375-1924. Available at: <>. Date accessed: 27 may 2024. doi:
Research Articles


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