Comparison of totally extraperitoneal versus Lichtenstein operation under local or general anesthesia for inguinal hernia: a meta-analysis.

Purpose: This meta-analysis compared totally extraperitoneal (TEP) laparoscopic repair with open Lichtenstein repair performed under local or general anaesthesia for unilateral inguinal hernia, asking whether the surgical or anaesthetic approach affects postoperative safety, pain and functional recovery.

Methods: PubMed, Embase, Cochrane and Web of Science were searched to 1 April 2025. Eighteen randomized and observational studies comprising 4302 patients met predefined inclusion criteria. Pooled risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed or randomeffects models; heterogeneity, sensitivity analyses and publication bias were assessed.​.

Results: No significant recurrence difference between TEP and Lichtenstein (RR = 0.85, 95% CI [0.51, 1.40]). TEP significantly reduced early-Stage Pain (RR = 0.62, 95% CI [0.49, 0.79]), wound infection (RR = 0.54, 95% CI [0.32, 0.91]) and accelerated return to normal activities (MD = -4.44, 95% CI [-6.06, -2.85]). Hematoma, seroma and hospital stay were similar. TEP had longer operative time (MD = 8.22 min, 95%CI[1.00,15.44]), but this gap disappeared in post-2013 studies. Subgroup analysis found that the lower infection risk of TEP was only significant when compared with Lichtenstein repair under local anesthesia (RR = 0.28, 95% CI [0.08, 0.96]).Sensitivity analysis confirmed the robustness of the results, and no publication bias was detected.

Conclusion: TEP and Lichtenstein repair are comparably safe and effective for inguinal hernia repair. TEP may reduce postoperative pain and wound infections, whereas Lichtenstein repair with local anesthesia is suitable for high-risk cardiopulmonary patients. Surgical choice depends on patient, anesthesia, and expertise.