Transabdominal Pre-Peritoneal Versus Open Repair for Primary Unilateral Inguinal Hernia: A Meta-analysis.

Abstract

Recent NICE guidelines recommend open surgical approaches for the treatment of primary unilateral inguinal hernias. However, many surgeons perform a laparoscopic approach based on the advantages of less post-operative pain and faster recovery. Our aim was to examine current evidence comparing transabdominal pre-peritoneal (TAPP) laparoscopic repair and open surgical repair for primary inguinal hernias. A systematic search of six electronic databases was conducted for randomised controlled trials (RCTs) comparing TAPP and open repair for primary unilateral inguinal hernia. A random-effects model was used to combine the data. A total of 13 RCTs were identified, with 1310 patients receiving TAPP repair and 1331 patients receiving open repair. There was no significant difference between the two groups for rates of haematoma (RR 0.92; 95% CI 0.49-1.71; P=0.78), seroma (RR 1.90; 95% CI 0.87-4.14; P=0.10), urinary retention (RR 0.99; 95% CI 0.36-2.76; P=0.99), infection (RR 0.61; 95% CI 0.29-1.28; P=0.19), and hernia recurrence (RR 0.67; 95% CI 0.42-1.07; P=0.10). TAPP repair had a significantly lower rate of paraesthesia (RR 0.20; 95% CI 0.08-0.50; P=0.0005), shorter bed stay (2.4±1.4 vs 3.1±1.6days, P=0.0006), and shorter return to normal activities (9.5±7.9 vs 17.3±8.4days, P<0.00001). Our findings demonstrated that TAPP repair did not have higher rate of morbidity or hernia recurrence and is an equivalent approach to open repair, with the advantages of faster recovery and reduced paraesthesia.