A Randomized Controlled Trial of Laparoscopic Inguinal Hernia Repair- Transabdominal Preperitoneal (TAPP) Versus Totally Extra Peritoneal (TEP) Approach

The following information from the literature was obtained by searching through the MEDLAR and PUBMED using the key words 'TAPP', 'TEP', 'Laparoscopy' and 'Inguinal hernia'.

Application of laparoscopic techniques has revolutionized the field of surgery. General surgeons have accepted laparoscopic surgery unequivocally. Few would dispute the tremendous success and the impact that laparoscopic cholecystectomy had on the management of gallstone.1 Laparoscopic inguinal hernia repair (LIHR) was introduced following the success of laparoscopic cholecystectomy on the premise that there would be less post-operative discomfort and pain, repair of recurrent hernias would be easier and bilateral hernia can be treated concurrently with improved cosmesis. Ger and Associates2 reported first laparoscopic inguinal hernia repair. Schultz et al3 were the first to report the use of prosthetic material during laparoscopic inguinal hernia repair.

LIHR has got comparable results in comparison to tension free open hernia repair (OHR). Many studies have shown that LIHR gives similar results in terms of recurrence as compared with OHR but with the added advantage of less chances of post operative, pain, wound infection and early return to activity4-6.

Laparoscopic inguinal human repair has undergone tremendous change since its introduction in 1990 by Ger et al3. LIHR was started using the transabdominal preperitoneal (TAPP) approach. TAPP repair involves formation of a peritoneal flap and placement of a mesh in the preperitoneal space. The mesh is then held in place using a tacker. Initially, TAPP became the commonly performed laparoscopic procedure and a number of studies demonstrated the efficacy of TAPP and its comparable results with tension free OHR4-7. Arvidasson D et al8 compared 5 years recurrence rates of laparoscopic inguinal hernia repair Vs. Shouldice repair of primary inguinal hernia which is considered the gold standard for open non-mesh repair of hernia. The cumulative recurrence rate after 5 years was 6.6% in the TAPP group and 6.7% in the Shouldice group. Thus, the TAPP operation represents an excellent alternative to primary inguinal repair.

Wara et al9 have demonstrated that laparoscopic repair compared favourably with Lichteinstein repair for primary indirect and direct hernias, unilateral and bilateral hernias, and recurrent hernias but was inferior for primary bilateral hernias.