COMPARATIVE STUDY OF EXTENDED TOTAL EXTRAPERITONEAL (ETEP) VERSUS TRANSABDOMINAL PRE-PERITONEAL (TAPP) REPAIR IN UNILATERAL INGUINAL HERNIA: A PROSPECTIVE RANDOMIZED STUDY

Abstract

Background: Inguinal hernia (IH) is one of the most prevalent surgical conditions worldwide, accounting for nearly 75% of all abdominal wall hernias, with a lifetime risk of 27% in males and 3% in females. Laparoscopic approaches have increasingly replaced open repair due to reduced postoperative pain, faster recovery, and lower recurrence rates. Among laparoscopic methods, the transabdominal pre-peritoneal (TAPP) and extended totally extraperitoneal (eTEP) approaches are widely used, yet evidence remains mixed regarding their relative superiority.

Aim: To compare perioperative outcomes and short-term complications of eTEP and TAPP repair in patients undergoing unilateral inguinal hernia surgery.

Methods: This prospective randomized study enrolled 90 patients with unilateral inguinal hernia, randomized into two groups: eTEP (n=45) and TAPP (n=45). Baseline demographics were recorded. Outcome parameters included operative duration, postoperative pain (Visual Analogue Scale [VAS], POD1–3), length of hospital stay, and complications. Statistical analysis was performed using SPSS v25, with p<0.05 considered significant.

Results: Mean operative time was significantly shorter in the eTEP group compared to the TAPP group (78.6 ± 8.4 vs 98.2 ± 10.1 minutes, p<0.001). Postoperative pain scores were lower in the eTEP group across POD1–3 (p<0.05). The mean hospital stay was shorter in eTEP patients (2.1 ± 0.6 vs 2.9 ± 1.2 days, p=0.03). Complication rates were slightly higher in TAPP (seroma, port-site infection), but not statistically significant.

Conclusion: eTEP provides shorter operative time, faster recovery, and comparable complication rates when compared to TAPP repair. It appears to be a preferable option for unilateral inguinal hernia repair; however, further multicenter trials with long-term follow-up are warranted.