Efficacy of totally extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review and meta-analysis.

IF 2.6 2区医学 Q1 SURGERY

Hernia Pub Date : 2025-04-01 DOI:10.1007/s10029-025-03322-x

María Alejandra Romero-Silva, Jose Caballero-Alvarado, Carlos Zavaleta-Corvera

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引用次数: 0

Abstract

Objective: To evaluate the efficacy and safety of totally extraperitoneal endoscopic hernioplasty (TEP) compared to the Lichtenstein hernioplasty in adult patients with uncomplicated inguinal hernia.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. We included 27 randomized controlled trials (RCTs) identified through comprehensive searches in Embase, Web of Science, PubMed, Scopus, and Cochrane Library. Studies comparing TEP and Lichtenstein techniques in adult patients with uncomplicated inguinal hernias were selected. Primary outcomes included hernia recurrence and chronic postoperative pain. Secondary outcomes assessed were surgical wound infection, seroma, hematoma, scrotal edema, operative time, hospital stay (in hours and days), and time to return to daily activities.

Results: A total of 27 RCTs with 7,658 patients were analyzed. No significant difference was found in hernia recurrence between TEP and Lichtenstein (RR 1.03; 95% CI [0.62-1.72]; p = 0.90). However, TEP significantly reduced the risk of chronic postoperative pain by 62% (RR 0.38; 95% CI [0.28-0.51]; p < 0.00001), surgical wound infection by 52% (RR 0.48; 95% CI [0.31-0.75]; p = 0.001), and hematoma formation by 37% (RR 0.63; 95% CI [0.41-0.97]; p = 0.04). No significant differences were found for seroma formation (RR 1.17; 95% CI [0.98-1.40]; p = 0.08) or scrotal edema (RR 0.62; 95% CI [0.35-1.10]; p = 0.10). Operative time showed no significant difference (MD 7.78 min; 95% CI [-2.77-18.33]; p = 0.15). Regarding hospital stay, TEP reduced the duration in days (MD -0.83; 95% CI [-1.24 to -0.41]; p < 0.0001), while no difference was observed when measured in hours (MD 0.01; 95% CI [-0.29-0.31]; p = 0.95). Furthermore, TEP was associated with a faster return to daily activities by approximately 5 days (MD -4.74; 95% CI [-6.78 to -2.70]; p < 0.00001).

Conclusion: The TEP technique is more effective in terms of chronic pain, risk of surgical wound infection, and reduction of hematoma formation than the Lichtenstein technique.

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.