Transabdominal Preperitoneal Versus Totally Extraperitoneal For Laparoscopic Hernia Repair Meta-analysis

Objective: Evaluate clinical application of laparoscopic transabdominal preperitoneal(TAPP) and totally extraperitoneal(TEP) approach of laparoscopic inguinal hernia repair,and provide a more ational and scientific choice for the surgeon. Method s: Through the literature retrieval, and set up criteria and exclusion standards strictly, after extracting the relevant data, according to the Cochrane bias risk assessment tool for quality assessment and Meta related literature analysis, draw the conclusion. Results: Nine RCT including 1034 patients were analyzed, including TAPP group(n=540) and TEP group(n=494).Postoperative 24 hours pain is higher coma-r ed TAPP group with TEP group(WMD=0.63, 95%CI 0.53~0.72, P<0.00001).TA-P P group compared with TEP group, the operation time for WMD2.61(95%CI-4.40~9.63,P=0.46), postoperative hospitalization time for SMD0.14(95%CI-0.02~0.30,P=0.09), postoperative recovery daily life time for SMD0.01(95%CI-0.16~0.19,P=0.71), postoperative recovery work time SMD were- 0.22(95%CI-0.22~0.17,P=0.80), Postoperative 6 hours pain for WMD 0.35(95%CI-0.43~1.13,P=0.38),Postoperative urinary retention OR value of incidence was 0.81(95%CI 0.36~1.80,P=0.61), Postoperative hematoma OR value of incidence was 0.84(95%CI 0.46~1.54,P=0.68), Postoperative effusion OR value of incidence was 1.17(95%CI 0.37~3.69,P=0.79), Postoperative incision infection OR value of incidence was 1.88(95%CI 0.82~4.32,P=0.14), Postoperative recurrence rates OR value of incidence was 1.28(95%CI 0.38~4.35,P=0.69). Except postoperative 24 hours pain is higher comared TAPP group with TEP group, the rest of the outcomes between thegroups were no obvious difference. Conclusions: The evidence currently available shows that Postoperative 24 hours pain is higher comared TAPP group with TEP group. The timing of the operation, postoperative recovery, postoperative recurence and complications between TAPP group and TEP group were no significant differences. Large-scale, high-quality RCTs are still needed to confirm or refuse the available evidence.