Skip to main content
SpringerLink
Log in

Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Although a large number of surgeons currently perform endoscopic hernia surgery using a total extraperitoneal (TEP) approach, reviews published to date are based mainly on trials that compare laparoscopic transabdominal preperitoneal (TAPP) repair with various types of open inguinal hernia repair.

Methods

A qualitative analysis of randomized trials comparing TEP with open mesh or sutured repair.

Results

In this review, 4,231 patients were included in 23 trials. In 10 of 15 trials, TEP repair was associated with longer surgery time than open repair. A shorter postoperative hospital stay after TEP repair than after open repair was reported in 6 of 11 trials. In 8 of 9 trials, the time until return to work was significantly shorter after TEP repair. Hospital costs were significantly higher for TEP than for open repair in all four trials that included an economic evaluation. Most trials (n = 14) reported no differences in subsequent recurrence rates between TEP and open repair.

Conclusions

The findings showed that endoscopic TEP repair is associated with longer surgery time, shorter postoperative hospital stay, earlier return to work, and recurrence rates similar to those for open inguinal hernia repair. The procedure involves greater expenses for hospitals, but appears to be cost effective from a societal perspective. The TEP technique is a serious option for mesh repair of primary hernias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Rutkow IM, Robbins AW (1993) Demographic, classificatory, and socioeconomic aspects of hernia repair in the United States. Surg Clin North Am 73: 413–426

    Article  CAS  Google Scholar 

  2. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157: 188–193

    Article  CAS  Google Scholar 

  3. Welsh DRJ, Alexander MAJ (1993) The Shouldice repair. Surg Clin North Am 73: 451–469

    Article  CAS  Google Scholar 

  4. Stoppa RE, Warlaumount CK (1995) The preperitoneal approach and prosthetic repair of groin hernias. In: Nyhus LM, Coldon RE (eds) Hernia. 4th ed. JB Lippincott, Philadelphia pp 118–210

    Google Scholar 

  5. EU Hernia Trialists Collaboration (2000) Mesh compared with nonmesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 87: 854–859

    Article  Google Scholar 

  6. Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM (2002) Open mesh versus nonmesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev 4 CD002197

  7. Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR (2003) Metaanalysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90: 1479–1492

    Article  CAS  Google Scholar 

  8. Edwards CC 2nd, Bailey RW (2000) Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 10: 149–153

    Article  Google Scholar 

  9. Medical Research Council Laparoscopic Groin Hernia Trial Group (2001) Cost-utility analysis of open versus laparoscopic groin hernia repair: results from a multicentre randomized clinical trial. Br J Surg 88: 653–661

    Article  Google Scholar 

  10. Tsang S, Normad R, Karlin R (1994) Small bowel obstruction: a morbid complication after laparoscopic herniorraphy. Am Surg 60: 332–334

    CAS  PubMed  Google Scholar 

  11. Darzi A, Paraskeva PA, Quereshi A, Menzies-Gow N, Guillou PJ, Monson JR (1994) Laparoscopic herniorraphy: initial experience in 126 patients. J Laparoendosc Surg 4: 179–183

    Article  CAS  Google Scholar 

  12. Phillips EH, Arregui M, Carroll BJ, Corbitt J, Crafton WB, Fallas MJ, Filipi C, Fitzgibbons RJ, Franklin MJ, McKernan B, et al (1995) Incidence of complications following laparoscopic hernioplasty. Surg Endosc 9: 16–21

    CAS  PubMed  Google Scholar 

  13. Kald A, Anderberg B, Smedh K, Karlsson M (1997) Transperitoneal or totally extraperitoneal approach in laparoscopic hernia repair: results of 491 consecutive herniorrhapies. Surg Laparosc Endosc 7: 86–89

    Article  CAS  Google Scholar 

  14. Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350: 1819–1827

    Article  CAS  Google Scholar 

  15. Bittner R, Sauerland S, Schmedt CG (2005) Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair: a metaanalysis of randomized controlled trials. Surg Endosc 19: 605–615

    Article  CAS  Google Scholar 

  16. Heikkinen TJ, Haukipuro K, Koivukangas P, Hulkko A (1998) A prospective randomized outcome and cost comparison of totally extraperitoneal endoscopic hernioplasty versus lichtenstein hernia operation among employed patients. Surg Laparosc Endosc 8: 338–344

    Article  CAS  Google Scholar 

  17. Andersson B, Hallén M, Leveau P, Bergenfelz A, Westerdahl J (2003) Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial. Surgery 133: 464–472

    Article  Google Scholar 

  18. Merello J, Guerra GA, Madriz J, Guerra GG (1997) Laparoscopic TEP versus open Lichtenstein hernia repair: randomized trial. Surg Endosc 11: 545

    Google Scholar 

  19. Bilgin B, Özmen MM, Zülfikaroglu B, Cete M, Hengirmen S (1997) Totally extraperitoneal (TEP) hernia repair preperitoneal open repair (PPOR). Surg Endosc 11: 542

    Google Scholar 

  20. Lal P, Kajla RK, Chander J, Saha R, Ramteke VK (2003) Randomized controlled study of laparoscopic total extraperitoneal vs open Lichtenstein inguinal hernia repair. Surg Endosc 17: 850–856

    Article  Google Scholar 

  21. Payne J, Izawa M, Glen P (1996) Laparoscopic or tension-free inguinal hernia repair? A cost benefit analysis of 200 prospective randomized patients. SAGES, Philadelphia

    Google Scholar 

  22. Colak T, Akca T, Kanik A, Aydin S (2003) Randomized clinical trial comparing laparoscopic totally extraperitoneal approach with open mesh repair in inguinal hernia. Surg Laparosc Endosc Percutan Tech 13: 191–195

    Article  Google Scholar 

  23. Bostanci BE, Tetik C, Özer S, Özden A (1998) Posterior approaches in groin hernia repair: open or closed. Acta Chir Belg 98: 241–244

    CAS  PubMed  Google Scholar 

  24. Champault G, Rizk N, Catheline JM, Riskalla H, Boutelier P (1996) Hernies de l’aine: traitment laparoscopique pré-péritoneal versus opération de Stoppa. Etude randomisée: 100 cas. J Chir 133: 274–280

    CAS  Google Scholar 

  25. Champault GG, Rizk N, Catheline JM, Turner R, Boutelier P (1997) Inguinal hernia repair: totally preperitoneal laparoscopic approach versus stoppa operation: randomized trial of 100 cases. Surg Laparosc Endosc 7: 445–450

    Article  CAS  Google Scholar 

  26. Suter M, Martinet O (2002) Postoperative pulmonary dysfunction after bilateral inguinal hernia repair: a prospective randomized study comparing the Stoppa procedure with laparoscopic total extraperitoneal repair (TEP). Surg Laparosc Endosc Percutan Tech 12: 420–425

    Article  CAS  Google Scholar 

  27. Suter M, Martinet O, Spertini F (2002) Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure. Surg Endosc 16: 1214–1219

    Article  CAS  Google Scholar 

  28. Khoury N (1998) A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: a study of 315 cases. J Laparoendosc Adv Surg Tech 8: 367–372

    Article  CAS  Google Scholar 

  29. Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B, Anderberg B (2003) Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein. Ann Surg 237: 142–147

    Article  Google Scholar 

  30. Wright DM, Kennedy A, Baxter JN, Fullarton GM, Fife LM, Sunderland GT, O’Dwyer PJ (1996) Early outcome after open versus extraperitoneal endoscopic tension-free hernioplasty: a randomized clinical trial. Surgery 119: 552–557

    Article  CAS  Google Scholar 

  31. Wright DM, Hall MG, Paterson CR, O’Dwyer PJ (1999) A randomized comparison of driver reaction time after open and endoscopic tension-free inguinal hernia repair. Surg Endosc 13: 332–334

    Article  CAS  Google Scholar 

  32. Simmermacher RK, Van Duyn EB, Clevers GJ, de Vries LS, van Vroonhoven TJMV (2000) Preperitoneal mesh in groin hernia surgery: a randomized trial emphasizing the surgical aspects of preperitoneal placement via a laparoscopic (TEP) or Grid-iron (Ugahary) approach. Hernia 4: 296–298

    Article  Google Scholar 

  33. Nathanson L, Adib R (1996) Randomized trial of open and laparoscopic inguinal hernia repair. Surg Endosc 10: 192

    Google Scholar 

  34. Bessell JR, Baxter P, Riddell P, Watkin S, Maddern GJ (1996) A randomized controlled trial of laparoscopic hernia repair. Surg Endosc 10: 495–500

    Article  CAS  Google Scholar 

  35. Decker D, Lindemann C, Springer W, Low A, Hirner A, von Ruecker A (1998) Endoscopic vs conventional hernia repair from an immunologic point of view. Surg Endosc 13: 335–339

    Article  Google Scholar 

  36. Fleming WR, Elliott TB, Jones RM, Hardy KJ (2001) Randomized clinical trial comparing totally extraperitoneal inguinal hernia repair with the Shouldice technique. Br J Surg 88: 1183–1188

    Article  CAS  Google Scholar 

  37. Champault G, Benoit J, Lauroy J, Rizk N, Boutelier P (1994) Hernies de l’aine de l’adulte: chirurgie laparoscopique vs opération de Shouldice: étude randomisée controlée: 181 patients: résultats préliminaires. Ann Chir 48: 1003–1008

    CAS  PubMed  Google Scholar 

  38. Liem MS, van der Graaf Y, van Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, Stassen LP, Vente JP, Weidema WF, Schrijvers AJ, van Vroonhoven TJ (1997) Comparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. N Engl J Med 336: 1541–1547

    Article  CAS  Google Scholar 

  39. Liem MS, van der Graaf Y, Zwart RC, Geurts I, van Vroonhoven TJ (1997) A randomized comparison of physical performance following laparoscopic and open inguinal hernia repair. Br J Surg 84: 64–67

    Article  CAS  Google Scholar 

  40. Liem MSL, Halsema JAM, van der Graaf Y, Schrijvers AJ, van Vroonhoven TJ (1997) Cost effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Ann Surg 6: 668–676

    Article  Google Scholar 

  41. Liem MSL, van Duyn EB, van der Graaf Y, van Vroonhoven TJ (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 237: 136–141

    Article  Google Scholar 

  42. Champault G, Barrat C, Catheline JM, Rizk N (1998) Hernies de l’aine. Résultats à 4 ans de deux études prospectives randomisées comparant les opérations de Shouldice et de Stoppa à l’abord laparoscopique totalement pré-péritonéal (461 patients). Ann Chir 52: 132–136

    CAS  PubMed  Google Scholar 

  43. Wright D, Paterson C, Scott N, Hair A, O’Dwyer PJ (2002) Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Ann Surg 235: 333–337

    Article  Google Scholar 

  44. Vatansev C, Belviranli M, Aksoy F, Tuncer S, Sahin M, Karahan O (2002) The effects of different hernia repair methods on postoperative pain medication and CRP levels. Surg Laparosc Endosc Percutan Tech 12: 243–246

    Article  Google Scholar 

  45. Knook MTT, Weidema WF, Stassen LPS, van Steensel CJ (1999) Endoscopic total extraperitoneal repair of primary and recurrent inguinal hernias. Surg Endosc 13: 507–511

    Article  CAS  Google Scholar 

  46. Lau H, Patil NG, Yuen WK, Lee F (2002) Management of peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 16: 1474–1477

    Article  CAS  Google Scholar 

  47. Collaboration EH (2000) Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg 87: 860–867

    Article  Google Scholar 

  48. Leibl BJ, Jager C, Kraft B, Kraft K, Schwarz J, Ulrich M, Bittner R (2005) Laparoscopic hernia repair: TAPP or/and TEP? Langenbecks. Arch Surg 390: 77–82

    Article  CAS  Google Scholar 

  49. The MRC Laparoscopic Groin Hernia Trial Group (1999) Laparoscopic versus open repair of groin hernia: a randomised comparison. Lancet 354: 185–190

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands

    E. Kuhry, R. N. van Veen, H. R. Langeveld & J. Jeekel

  2. Department of Public Health, Erasmus University, Rotterdam, The Netherlands

    E. W. Steyerberg

  3. Department of Surgery, Namsos Sykehuset, 7800, Namsos, Norway

    E. Kuhry

  4. Department of Surgery, Dalhousie University, Halifax, Canada

    H. J. Bonjer

Authors
  1. E. Kuhry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. N. van Veen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. R. Langeveld
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. W. Steyerberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Jeekel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. J. Bonjer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Kuhry.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kuhry, E., van Veen, R.N., Langeveld, H.R. et al. Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21, 161–166 (2007). https://doi.org/10.1007/s00464-006-0167-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-006-0167-4

Keywords

Search

Navigation