Comparison of Transabdominal Preperitoneal and Totally Extraperitoneal Repair in Laparoscopic Inguinal Hernia: A Randomized,Clinical Trial on Postoperative Complications,Pain,and Functional Recovery

Abstract

Background:

Laparoscopic repair is recommended for inguinal hernia because it is associated with reduced postoperative pain and faster recovery compared with open repair. However, the choice between transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques remains controversial.

Methods:

A prospective randomized, clinical trial was conducted between November 2021 and June 2025. Adult male patients with unilateral uncomplicated inguinal hernias were included. Patients were randomized in a 1:1 ratio to undergo TAPP or TEP repair. The primary endpoint was 30-day postoperative complications graded according to the Clavien–Dindo classification. Secondary endpoints included chronic pain, functional recovery, and recurrence.

Results:

A total of 144 patients were included and randomized, with 72 patients in each group. Briefly, 30-day postoperative complications were significantly more frequent after TAPP than TEP (19.4% versus 6.9%, P = .024). Most complications were minor (Grades I–II), and three Grade IIIa events required percutaneous aspiration. Chronic pain at 3 months was observed in 5.6% of patients after TAPP and 1.4% after TEP (P = .181). Time to return to normal activity did not differ significantly between groups. After a median follow-up of 26 months, the recurrence rate was 2.8% in both groups.

Conclusion:

TEP was associated with significantly lower short-term postoperative complications and shorter hospital stays, while long-term outcomes were comparable between techniques.