Laparoscopic transabdominal preperitoneal (TAPP) versus open Lichtenstein primary unilateral inguinal hernia repair: A systematic review and meta-analysis of randomized controlled trials.

Abstract

Laparoscopic transabdominal preperitoneal and open Lichtenstein repairs are established techniques for primary unilateral inguinal hernia, yet prior studies have reported differing conclusions regarding several key outcomes. To compare perioperative and long-term outcomes between laparoscopic transabdominal preperitoneal and open Lichtenstein repair for primary unilateral inguinal hernias using data from randomized controlled trials. A systematic review and meta-analysis was conducted, comparing primary unilateral inguinal hernia repair using either laparoscopic transabdominal preperitoneal or Lichtenstein repair in adults. Random-effects models were used to estimate pooled mean differences and risk ratios with 95% confidence intervals. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Seventeen studies were included. Transabdominal preperitoneal repair resulted in significantly lower postoperative pain on day 0 (mean difference = -1.75, 95% CI -2.48 to -1.01), day 1 (mean difference = -0.72, 95% CI -1.37 to -0.07), and week 1 (mean difference = -1.14, 95% CI -1.76 to -0.52). Compared with Lichtenstein repair, TAPP was associated with reduced risks of surgical site infection (risk ratio = 0.36, 95% CI 0.17-0.76), hematoma (risk ratio = 0.27, 95% CI 0.14-0.52), chronic pain (risk ratio = 0.42, 95% CI 0.20-0.88), and short-term recurrence (risk ratio = 0.26, 95% CI 0.08-0.90). No significant differences were observed in return to normal activity, hospital stay, or long-term recurrence. Among adults undergoing primary unilateral inguinal hernia repair, transabdominal preperitoneal repair provides superior early outcomes and reduced chronic pain without increasing long-term recurrence, reinforcing its role as an effective minimally invasive option.