Laparoscopic totally extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) for bilateral inguinal hernia repair: a systematic review and meta-analysis.

PURPOSE: This meta-analysis compared perioperative outcomes between Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) for bilateral inguinal hernia repair. METHODS: PubMed, EMBASE, and the Cochrane Library were searched for randomized controlled trials and observational studies comparing TEP and TAPP. Risk ratios (RRs) were used for dichotomous outcomes and mean differences (MDs) for continuous outcomes, both with 95% confidence intervals (CIs). Data were pooled using a random-effects model. Single-arm meta-analysis assessed the rate of TEP to TAPP conversion. RESULTS: Of 1,244 studies screened, 92 were fully reviewed. Eleven studies including 1,714 patients were included. Of these, 910 (53.09%) underwent TEP. No significant differences were observed in hernia recurrence, intraoperative complications, operative time, conversion to open repair, VAS pain score at 24 h, hematoma, seroma, wound infection, urinary complications, length of hospital stay and time to return to work. Sensitivity analysis excluding one study showed significantly lower hernia recurrence and fewer conversions to open surgery in TAPP. Conversion to open repair occurred in 2.92% of TEP cases and 0% of TAPP cases, while conversion from TEP to TAPP was 2.3%. CONCLUSION: Although TEP and TAPP showed comparable safety and efficacy for bilateral inguinal hernia repair, TAPP may be associated with fewer hernia recurrences and conversion to open repair. Choice of technique should depend on surgeon expertise, patient factors, and available resources rather than expected differences in outcomes.