Laparoscopic mesh repair has become widely accepted for inguinal hernia due to faster recovery, reduced pain, and comparable recurrence rates when compared with open repair.¹,² Among endoscopic techniques, TAPP requires peritoneal entry, while TEP avoids breaching the peritoneum.³,⁴ Although both are effective, their comparative advantages remain debated in guidelines and meta-analyses.⁵⁻⁷ This study aimed to prospectively compare TEP and TAPP regarding operative efficiency, early pain, complications, hospital stay, and six-month recurrence.

SUBJECTS AND METHODS

Study design and setting: This prospective comparative study was conducted between March 2023 and June 2024 at a tertiary-care teaching hospital, with six-month postoperative follow-up.

Eligibility: Inclusion criteria were adults ≥18 years with primary inguinal hernia (direct/indirect, unilateral/bilateral), fit for surgery, and providing informed consent. Exclusion criteria included unfitness for anaesthesia, coagulopathy, complicated hernias (irreducible/obstructed/strangulated), and femoral/ventral hernias.

Allocation and blinding: Patients were allocated to TEP (n=25) or TAPP (n=25) groups and were blinded to the intervention.

Surgical technique: Standardised laparoscopic TEP and TAPP repairs were performed by experienced surgeons using mesh placement as described in prior literature. Postoperatively, patients received uniform analgesia protocols.

 
Outcomes: Primary outcomes were POD-1 pain (VAS, 0–10 scale) and hernia recurrence. Secondary outcomes included operative time, vascular injury, seroma, haematoma, port-site infection, surgical emphysema, and hospital stay. Follow-up assessments were conducted at 24 h, day 10, three months, and six months.

Sample size: A convenience sample of 50 consecutive patients (25 per group) was included. No formal power calculation was performed due to time-bound nature of the study.

Statistical analysis: Data were analysed using MedCalc software. Continuous variables were expressed as mean ± SD and compared with unpaired t-test. Categorical variables were analysed with odds ratio/Z test. A p-value <0.05 was considered statistically significant.

Ethics: The study was approved by the Institutional Ethics Committee two months prior to initiation (Approval No.: [MKSMCRC/IEC/SERC/2147, Date: 24/03/2023]). Written informed consent was obtained. The study adhered to the Declaration of Helsinki (2013).

RESULTS

Fifty male patients were included (TEP = 25, TAPP = 25). Baseline characteristics are shown in Table 1.

Table 1. Baseline characteristics of study participants.

Operative and postoperative outcomes are presented in Table 2. TEP showed significantly shorter operative time, lower POD-1 pain scores, and shorter hospital stay compared to TAPP.

Table 2. Operative and postoperative outcomes.

Complications and recurrence rates are shown in Table 3. No significant differences were noted between groups.

Table 3. Postoperative complications and recurrence at six months.

DISCUSSION

This study found that TEP was associated with shorter operative time, less early postoperative pain, and shorter hospital stay compared with TAPP, while complication rates and recurrence were similar. These results are consistent with prior studies and meta-analyses.⁸⁻¹⁰ The lower pain in TEP may be attributed to avoidance of peritoneal entry and reduced visceral handling.¹¹ A slightly higher incidence of seroma in TEP has also been reported in other studies.¹² Overall complication rates were low and consistent with international registries.¹³ ¹⁴

Strengths of this study include its prospective design, predefined outcomes, and structured follow-up. Limitations include small sample size, single-centre design, male-only cohort, lack of randomisation, and short follow-up of six months. Future randomised trials with larger samples and longer follow-up are needed to further validate these findings.¹⁵

CONCLUSION

Both TEP and TAPP are safe and effective for inguinal hernia repair. TEP provided lower pain, shorter operative time, and shorter hospital stay, while complications and short-term recurrence rates were similar. Where expertise is available, TEP may be preferred for improved early recovery.

DECLARATION

Conflicts of interests: The authors declare no conflicts of interest.

Author contribution: All authors have contributed in the manuscript.

Author funding: Nill

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