A Systematic Review and Meta-analysis of Randomized Controlled Trials on Comparing Transabdominal Preperitoneal Versus Lichtenstein Operations for Primary Inguinal Hernia Repair

Abstract

Background: Inguinal hernia repair is a common surgical operation being performed worldwide, and the primary objective of hernia repair is to reduce recurrence, minimize complications, and robust recovery. This systematic review and meta-analysis reviewed and compared two widely used surgical techniques: the Trans-abdominal Pre-peritoneal (TAPP) repair, a minimally invasive laparoscopic surgical technique, and the Lichtenstein operation, which is an open repair.

Methods: A thorough search was conducted across several databases, including PubMed, Cochrane Library, Google Scholar, and Web of Science, from 2004 to August 2024. We searched a combination of keywords and medical subject-related headings related to "trans abdominal Pre-peritoneal," "TAPP Surgical Technique," "Lichtenstein open repair operation," "primary inguinal hernia," and "randomized controlled trials (RCTs)."

Studies included in the meta-analysis were grouped based on the primary outcomes of interest to elaborate a comprehensive analysis. In addition to the surgical operation and hospital stay duration, acute post-operative pain, return to work time, hematoma, wound infection, and seroma incidence were also measured. The Randomized controlled trials (RCTs) comparing TAPP and Lichtenstein operations for primary inguinal hernia repair and studies reporting on at least one of the above-mentioned outcomes were included. The studies with patients having incarcerated hernia, femoral or bilateral hernias were excluded. The risk of bias for included studies was assessed using the Cochrane Risk of Bias tool and sed on odds ratios (ORs), standardized mean differences (SMDs) and confidence intervals (CIs), a quantitative meta-analysis study was conducted.

Results: Nine Randomized Controlled Trials (RCTs) comparing the TAPP and Lichtenstein technique for primary inguinal hernia repair were included in the meta-analysis. The duration of the surgical procedure was longer in the TAPP group (46.3 to 96.12 minutes), compared to the Lichtenstein group (27.8 to 54.2 min). In terms of acute post-operative pain, the TAPP group reported lower pain scores (mean: 5.66) compared to the Lichtenstein group (mean: 8.53). The overall complication rate was lower for the TAPP group (Odds Ratio = 0.461) as compared to Lichtenstein repair.

Conclusion: The meta-analysis concluded that TAPP tops out with benefits like less post-operative pain and a robust recovery period. However, the Lichtenstein technique remains a widely used option, especially in settings where access to advanced Laparoscopic facilities and expertise might not be available.