Laparoscopic totally extraperitoneal (TEP) versus transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernia repair: a systematic review and meta-analysis
In brief
TAPP cuts bilateral hernia recurrence by about three quarters
A meta-analysis of 1,164 patients found that the transabdominal preperitoneal (TAPP) approach reduced hernia recurrence to roughly one quarter of the rate seen with totally extraperitoneal (TEP) repair. Pain, hospital stay and operative time were similar, but patients returned to daily activities sooner after TAPP. Larger trials are needed to confirm these advantages.
- Journal
- Surgical endoscopy (Q1)
- Published
- 3 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Wei-Juo Tzeng, Yueh-Wei Liu, Yu-Yin Liu, Wei-Feng Li, Shih-Min Yin, Yu-Hung Lin, et al.
- PMID
- 42693204
- DOI
- 10.1007/s00464-026-13206-5
Why clinicians should know about it
- Picked for Surgery (paper of the day, 6 September 2026): TEP vs TAPP bilateral inguinal hernia repair meta‑analysis
Abstract
BACKGROUND: The optimal laparoscopic approach for bilateral inguinal hernia repair is unclear. The 2 primary methods are totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches. We conducted a systematic review and meta-analysis to compare surgical outcomes of TEP and TAPP for bilateral inguinal hernia repair. METHODS: PubMed, EMBASE, and CENTRAL databases were searched through April 15, 2025. Studies comparing TEP and TAPP in adults with bilateral inguinal hernias were included. Outcomes assessed included hernia recurrence, pain scores, length of hospital stay (LOS), operation time, return to activities of daily living, and complications. Odds ratios (ORs) and standardized mean differences (SMDs) were pooled using fixed or random effects models. RESULTS: Three randomized controlled trials (RCTs) and 4 retrospective studies with a total of 1164 patients were included in the analysis. Hernia recurrence was significantly lower with TAPP compared to TEP (pooled OR 0.27, 95% confidence interval [CI] 0.11-0.67; I2 = 8.2%). No significant differences were observed in 24-h pain score (SMD = - 0.96, 95% CI - 4.36 to 2.44), 7-day pain score (SMD = - 4.60, 95% CI - 53.77 to 44.56), LOS (SMD = 0.00, 95% CI - 0.79 to 0.79), or operation time (SMD = - 0.84, 95% CI - 3.44 to 1.75). Return to activities of daily living favored TAPP (SMD = - 0.53, 95% CI - 0.97 to - 0.09). Complications including seromas, wound infections, and urinary retention did not significantly differ between groups. CONCLUSIONS: TAPP is associated with lower recurrence risk and earlier recovery compared to TEP. Further large-scale, high-quality trials are needed to validate these findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.