Totally extraperitoneal laparoscopic hernioplasty versus open extraperitoneal approach for inguinal hernia repair: a meta-analysis of outcomes of our current knowledge

Surgeon. 2014 Apr;12(2):94-105. doi: 10.1016/j.surge.2013.11.018. Epub 2013 Dec 8.


Background: The aim of this article is to explore the clinical effects between open extraperitoneal approaches and totally extraperitoneal laparoscopic hernioplasty (TEP) in the repair of inguinal hernias.

Methods: The electronic databases Pubmed, Medline, Embase, Web of science and the Cochrane Library were used to search for articles from January 1992 to March 2013. The present meta-analysis pooled the effects of outcomes of a total of 1157 patients with 1377 hernias enrolled into 10 randomized controlled trials and 2 comparative studies. The data was analyzed using the statistic software Stata12.0 and IBM SPSS Statistics 19.

Results: Significant advantages of totally extraperitoneal laparoscopic hernioplasty (TEP) compared to the open extraperitoneal approach include a lower incidence of total postoperative complications (Odds Ratio, 0.544; 95% confidence interval, 0.369-0.803), a reduction in urinary problems (0.206[0.064,0.665]), an earlier return to normal activities or work (SMD = -1.798[-3.322,-0.275]), and a shorter length of hospital stay (-1.995 [-2.358,-1.632]). No difference was found in operative time, the incidence of hernia recurrence, chronic pain, intraoperative complications, seromas or hematomas, wound infection and testicular problems between the two techniques. One significant advantage for the open extraperitoneal inguinal hernia repair was a lower incidence of peritoneal tears (46.504 [15.399,140.437]).

Conclusions: Totally extraperitoneal laparoscopic hernioplasty (TEP) and open extraperitoneal mesh repair are equivalent in most of the analyzed outcomes. TEP is associated with shorter hospital stay, quicker return to normal activities or work, lower incidence of total postoperative complications and urinary problems, while the open extraperitoneal method has less incidence of peritoneal tears.

Keywords: Hernioplasty; Inguinal hernia; Meta-analysis; Open extraperitoneal approach; Randomized controlled trials; TEP.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Hernia, Inguinal / surgery*
  • Herniorrhaphy / methods*
  • Humans
  • Laparoscopy / methods*
  • Laparotomy / methods*
  • Peritoneum
  • Surgical Mesh*
  • Treatment Outcome