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Primary inguinal hernia: systematic review and Bayesian network meta-analysis comparing open, laparoscopic transabdominal preperitoneal, totally extraperitoneal, and robotic preperitoneal repair

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Abstract

Purpose

The Open Lichtenstein technique, the Laparoscopic Trans-Abdominal PrePeritoneal (TAPP), the Totally Extra Peritoneal (TEP), and the robotic TAPP (rTAPP) are commonly performed. The aim of the present network meta-analysis was to globally compare short-term outcomes within these major surgical techniques for primary unilateral inguinal hernia repair.

Methods

PubMed, EMBASE, and Web of Science were consulted. A fully Bayesian network meta-analysis was performed.

Results

Sixteen studies (51.037 patients) were included. Overall, 35.5% underwent Open, 33.5% TAPP, 30.7% TEP, and 0.3% rTAPP. The postoperative seroma risk ratio (RR) was comparable considering TAPP vs. Open (RR 0.91; 95% CrI 0.50–1.62), TEP vs. Open (RR 0.64; 95% CrI 0.32–1.33), TEP vs. TAPP (RR 0.70; 95% CrI 0.39–1.31), and rTAPP vs. Open (RR 0.98; 95% CrI 0.37–2.51). The postoperative chronic pain RR was similar for TAPP vs. Open (RR 0.53; 95% CrI 0.27–1.20), TEP vs. Open (RR 0.86; 95% CrI 0.48–1.16), and TEP vs. TAPP (RR 1.70; 95% CrI 0.63–3.20). The recurrence RR was comparable when comparing TAPP vs. Open (RR 0.96; 95% CrI 0.57–1.51), TEP vs. Open (RR 1.0; 95% CrI 0.65–1.61), TEP vs. TAPP (RR 1.10; 95% CrI 0.63–2.10), and rTAPP vs. Open (RR 0.98; 95% CrI 0.45–2.10). No differences were found in term of postoperative hematoma, surgical site infection, urinary retention, and hospital length of stay.

Conclusions

This study suggests that Open, TAPP, TEP, and rTAPP seem comparable in the short term. The surgical management of inguinal hernia is evolving and the effect of the adoption of innovative minimally invasive techniques should be further investigated in the long term. Ultimately, the choice of the most suitable treatment should be based on individual surgeon expertise and tailored on each patient.

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Authors and Affiliations

  1. Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant’Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy

    A. Aiolfi, G. Bonitta & D. Bona

  2. Department of Surgery, Istituto Clinico Sant’Ambrogio, University of Insubria, Milan, Italy

    M. Cavalli, F. Lombardo, A. Morlacchi, P. G. Bruni & G. Campanelli

  3. Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant’Ambrogio, University of Milan, Milan, Italy

    G. Micheletto

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  1. A. Aiolfi
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Contributions

AA, FL, AM, and GC did the literature search; AA, FL, and GC formed the study design; Data collection was done by AA, FL, MC, and AM. AA, GB, and DB analysed the data; AA, GM, and DB interpreted the data; AA, GB, and DB wrote the manuscript; AA, DB, and GC critically reviewed the manuscript.

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Correspondence to A. Aiolfi.

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AA, MC, GM, FL, GB, AM, PGB, GC, and Db declare no conflicts of interest.

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The article is part of the Topical Collection “Forum on primary monolateral uncomplicated inguinal hernia”.

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Aiolfi, A., Cavalli, M., Micheletto, G. et al. Primary inguinal hernia: systematic review and Bayesian network meta-analysis comparing open, laparoscopic transabdominal preperitoneal, totally extraperitoneal, and robotic preperitoneal repair. Hernia 23, 473–484 (2019). https://doi.org/10.1007/s10029-019-01964-2

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