Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial.

BACKGROUND: Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the "best groin hernia repair." The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair. METHODS: The present prospective randomized study was conducted between May 2007 and March, 2009 and included 100 patients suffering from uncomplicated primary groin hernia. Patients were randomized into group I (TEP) and group II (TAPP). Intraoperative variables and postoperative pain scores were recorded in a prestructured form. RESULTS: One hundred patients were included in the study (TEP, 53; TAPP, 47). Both groups were comparable in terms of demographic profile and hernia characteristics. The average operative time was higher in the TAPP group (p = 0.209). The pain scores at 1 h and 24 h after surgery and at 3-month follow-up were significantly higher in the TAPP group (p < 0.05). The average follow-up was 30.5 months. In the TEP group, 37.8% of patients had seroma compared to 18.3% in the TAPP group (p = 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (16 vs. 9, p = 0.009). The wound infection rates were equal (2% vs. 3%). There has been no recurrence in either group during the follow-up period of 44 months. Overall, the patients were more satisfied with TEP rather than TAPP (p < 0.05). CONCLUSIONS: In the present study, TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.

A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias.

INTRODUCTION: After the first report of laparoscopic incisional and ventral hernia repair (LIVHR) in 1993, several studies have proven its efficacy over open method. Among the technical issues, the technique of mesh fixation to the abdominal wall is still an area of debate. This prospective randomized study was done to compare two techniques of mesh fixation, i.e., tacker with four corner transfascial sutures versus transfascial sutures alone. MATERIALS AND METHODS: 68 patients admitted for LIVHR repair (defect size less than 25 cm2) were randomized in two groups: group I, tacker fixation (36 patients) and group II, suture fixation (32 patients). Various intraoperative variables and postoperative outcomes were recorded and analyzed. RESULTS: The patients in the two groups were well matched in terms of age, sex, body mass index (BMI), and hernia characteristics. Mean BMI was 29.0 kg/m2. Operative time was found to be significantly higher in group II (77.5 versus 52.6 min, p=0.000). Patients in group I were found to have significantly higher pain scores at 1 h, 6 h, 24 h, 1 week, 1 month, and 3 months postoperatively. At follow-up, incidence of seromas was higher in group II but the difference was not significant (7 versus 4, p=0.219). During long-term follow-up, patients in group II were satisfied cosmetically. CONCLUSION: Suture fixation is a cost-effective alternative to tacker fixation, for small and medium-sized defects in anatomically accessible areas. However, suture fixation requires significantly longer operation time, but patients have statistically significantly less postoperative pain.