Lichtenstein vs TAPP vs TEP. Which repair to choose?
DOI:
https://doi.org/10.32782/2415-8127.2023.68.1Keywords:
inguinal hernia, learning curve, tailored approach, Lichtenstein procedure, TAPP, TEPAbstract
Introduction. In the currently available systematic reviews and meta-analyses, dedicated to the comparison of laparoendoscopic and open repair of inguinal hernia, there is no clear consensus regarding which technique provides the best overall results. Materials and methods. We performed surgical treatment of 211 patients with uncomplicated inguinal hernia. 229 planned procedures were performed (18 patients with bilateral hernias). Patients were divided into three groups, depending on the method of hernia repair. Lichtenstein procedure was performed in 65 (Lichtenstein group), transabdominal preperitoneal hernia repair in 81 (TAPP group) and total extraperitoneal hernia repair in 65 (TEP group). We evaluated the duration of the procedure and pain using the Visual Analogue Scale. Results and discussion. The duration of the procedure in patients with Nyhus-I, Nyhus-II, and Nyhus-IIIa who underwent TEP was the longest and was not statistically different. The repair technique for primary large indirect and scrotal hernias had its own characteristics. This was reflected in the extension of the duration of the procedure. Pain in the TEP group was not statistically higher compared to the Lichtenstein and TAPP groups. Conclusions. For the treatment of an inguinal hernia, three equivalent tension-free procedures are currently recommended: Lichtenstein, TAPP and TEP. However, the choice of repair in patients with inguinal hernia should be individualized and consistent with the qualifications and practical skills of the surgeon. The Lichtenstein procedure is more often the method of choice for inguinal hernia repair in southern and eastern European countries, while TAPP and TEP predominate in central Europe and some northern European countries (Denmark and Norway).
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