Ozel Yahya, Ergenc Muhammer, Emir Servet, Kara Yalcin Burak
General Surgery Department, VM Medical Park Pendik Hospital, 34899 Istanbul, Turkiye; Dogus University Vocational School, 34775 Istanbul, Turkiye.
General Surgery Department, Marmara University Pendik Training and Research Hospital, 34899 Istanbul, Turkiye.
Ann Ital Chir. 2025;96(5):703-712. doi: 10.62713/aic.3852.
Inguinal hernia is a common surgical issue, with laparoscopic techniques such as totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) being widely used. However, there is no clear consensus on the superiority of either method for unilateral primary or recurrent inguinal hernias. This study compares TEP and TAPP, focusing on efficacy, safety, and clinical outcomes.
This study included patients who underwent elective laparoscopic surgery for unilateral inguinal hernias between April 2009 and May 2024. Patients who underwent inguinal hernia repair were divided into two groups according to whether the TAPP or TEP procedure was used. Primary and recurrent cases were analyzed, with data on demographic features such as age, gender, body mass index (BMI), operative duration, hospital stay, and complications compared between the groups.
Of the 985 patients, 72.6% underwent TAPP and 27.4% underwent TEP. The median BMI was significantly higher in the TAPP group (24.23 [23.4-25.6] vs. 24.00 [23.06-25.62], p = 0.038). The proportion of recurrent hernias was higher in the TEP group (15.6% vs. 9.0%, p = 0.004). Operative time was significantly longer for TEP compared to TAPP (60.0 [40-80] vs. 35.0 [25-45] minutes, p < 0.001). Although the median hospital stay was the same in both groups (1 [1] vs. 1 [1] days), the TAPP group had a wider range of hospital stays (p < 0.001). Complication rates were higher in the TEP group (11.1% vs. 4.3%, p < 0.001), primarily driven by increased seroma formation. Linear regression analysis revealed a significant association between case volume and operative duration for TEP primary cases (p < 0.001, R2 = 0.380), recurrent TEP cases (p = 0.024, R2 = 0.121), primary TAPP cases (p = 0.017, R2 = 0.009), and recurrent TAPP cases (p = 0.627, R2 = 0.004).
Both TAPP and TEP are effective for unilateral inguinal hernia repair; however, TAPP demonstrated shorter operative times, and fewer complications compared to TEP. Case volume significantly influences operative duration, particularly in TEP repairs. Further studies with larger cohorts are warranted to refine surgical approaches and outcomes.
腹股沟疝是一种常见的外科问题，全腹膜外（TEP）和经腹腹膜前（TAPP）等腹腔镜技术被广泛应用。然而，对于单侧原发性或复发性腹股沟疝，两种方法哪种更具优势尚无明确共识。本研究比较TEP和TAPP，重点关注疗效、安全性和临床结果。
本研究纳入了2009年4月至2024年5月期间接受择期腹腔镜单侧腹股沟疝手术的患者。接受腹股沟疝修补术的患者根据采用TAPP还是TEP手术分为两组。对原发性和复发性病例进行分析，比较两组患者的年龄、性别、体重指数（BMI）、手术时长、住院时间和并发症等人口统计学特征数据。
985例患者中，72.6%接受了TAPP手术，27.4%接受了TEP手术。TAPP组的BMI中位数显著更高（24.23[23.4 - 25.6] vs. 24.00[23.06 - 25.62]，p = 0.038）。TEP组复发性疝的比例更高（15.6% vs. 9.0%，p = 0.004）。与TAPP相比，TEP的手术时间显著更长（60.0[40 - 80] vs. 35.0[25 - 45]分钟，p < 0.001）。尽管两组的住院时间中位数相同（1[1]天 vs. 1[1]天），但TAPP组的住院时间范围更广（p < 0.001）。TEP组的并发症发生率更高（11.1% vs. 4.3%，p < 0.001），主要原因是血清肿形成增加。线性回归分析显示，TEP原发性病例、复发性TEP病例、原发性TAPP病例和复发性TAPP病例的病例数量与手术时长之间存在显著关联（TEP原发性病例：p < 0.001，R2 = 0.380；复发性TEP病例：p = 0.024，R2 = 0.121；原发性TAPP病例：p = 0.017，R2 = 0.009；复发性TAPP病例：p = 0.627，R2 = 0.004）。
TAPP和TEP对于单侧腹股沟疝修补均有效；然而，与TEP相比，TAPP的手术时间更短，并发症更少。病例数量显著影响手术时长，尤其是在TEP修补术中。有必要进行更大样本量的进一步研究以优化手术方法和结果。
