A Comparative Randomized Parallel Group Study between the Classical TAPP Repair and Modified TAPP Surgical Method for Inguinal Hernia Repair

Abstract

Objective: To compare equality of clinical outcome of simultaneous bilateral transabdominal preperitoneal (TAPP) repair of inguinal hernia by classical TAPP, with meticulous closure of peritoneal flap and modified TAPP, with peritoneal nonclosure and controlled release of pneumoperitoneum. Study to answer the research question—‘is meticulous closure of peritoneal flap, the only way to provide adequate cover for the mesh in TAPP repair?’ Summary and background data: The objective of meticulous closure of peritoneum is to prevent internal herniation while covering the mesh adequately to avoid contact between mesh and abdominal viscera. The study proposes same objective can also be achieved with nonclosure of peritoneum. Patients and methods: Between August 2011 and July 2012, 130 inguinal hernias of 65 patients who underwent TAPP repair were randomized in two groups. One group (n = 65) of hernias received classical repair with peritoneal closure (control), while the other (n = 65) without closure (study). The primary end points were bowel related complications and recurrence. Results: The two groups were comparable in age and types of hernia. Transabdominal preperitoneal was successfully done in all cases. No bowel-related complication and recurrence occurred in either group. Mean operating time was significantly less with modified TAPP (65 mins vs 76 mins, p < 0.05). Lower incidence of chronic pain (3 vs 13.84%, p = 0.007) and seroma (7.69 vs 15.38%) was achieved during mean follow-up of 628 days. Conclusion: The randomized prospective parallel group study demonstrated equality in clinical outcome on both primary end points by providing equivalent peritoneal cover for the mesh as meticulous peritoneal closure does in classical TAPP.