N. Liu1, Y. Xu1, L. M. Funk1,2, J. A. Greenberg1, A. L. Shada1, A. O. Lidor1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA 2William S. Middleton Veterans Affairs,Madison, WI, USA
Introduction: Inguinal hernia repair is one of the most commonly performed general surgery procedures. Herniorrhaphy can be performed through open surgery or laparoscopically. Laparoscopic repair utilizes either a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The literature remains mixed on outcomes when comparing TAPP versus TEP. The objective of our study was to compare postoperative outcomes between TAPP and TEP inguinal hernia repair.
Methods: All adult patients who underwent elective, outpatient laparoscopic inguinal hernia repair at a single institution academic center between 2013-2019 were retrospectively identified from the electronic health record. Baseline and preoperative characteristics were compared between surgery types using chi-squared test or Fisher’s exact test. Postoperative complications including related emergency department (ED) visits, readmissions, and reoperations within 6 months of surgery were compared using chi-squared test or Fisher’s exact test.
Results: We included 733 patients who underwent TAPP and 840 patients who underwent TEP. Patients who underwent TAPP were more likely to be obese (22.0% with a BMI ≥ 30 kg/m2 vs. 16.2% for TEP, p=0.003), have previous abdominal surgery (45.9% vs. 34.8%, p<0.001), and take blood thinners preoperatively (6.1% vs. 2.4%, p<0.001). Postoperatively, TAPP patients were more likely to receive urinary catheters (3.6% vs. 1.9%, p=0.043). There was no difference in ED visits within 6 months of surgery between TAPP and TEP (8.1% vs. 6.0%, p=0.102), however TAPP patients had a higher rate of readmissions within 6 months (4.0% vs. 1.7%, p=0.006). TAPP patients also had a higher rate of reoperations within 6 months (2.5% vs. 0.7%, p=0.005), with bowel and hernia-related complications as the most common indication for reoperation (1.5% for TAPP vs. 0.1 for TEP, p=0.002) (Table).
Conclusion: Both TAPP and TEP inguinal hernia repair have low rates of postoperative complications, including related readmissions and reoperations within 6 months of surgery. However, TEP repairs had lower rates of reoperations for bowel and hernia-related complications. Further studies are indicated to determine the long-term healthcare utilization and cost impact of these outcome differences between TAPP and TEP inguinal hernia repair.
