Prospective comparison of post-operative quality of life (QOL) after laparoscopic total extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) repair of indirect inguinal hernia
DOI:
https://doi.org/10.18203/2349-2902.isj20183208Keywords:
Totally extra peritoneal hernia repair, Trans abdominal pre-peritoneal repair, Quality of lifeAbstract
Background: As the laparoscopic method is becoming a popular choice of repair, the need to evaluate its impact on the patient’s quality of life (QOL) is also warranted. This study was undertaken to compare post operative QOL in patients undergoing Totally Extraperitoneal (TEP) and Transabdominal preperitoneal (TAPP) repair for indirect inguinal hernia.
Methods: This prospective observational study was conducted in the Department of General Surgery at VMMC and Safdarjung Hospital, from June 2016 to March 2018. Patients with uncomplicated indirect inguinal hernia were included in the study after obtaining their informed consent. Post-operative QOL was evaluated using EuraHS-QOL scale at 24 hours and 1, 3 and 6 months after the surgery.
Results: A total of sixty patients were enrolled-30 in TEP group and 30 in TAPP group. There was no statistical significant difference in scores at 24 hours follow-up except cosmetic discomfort domain, with higher scores in TAPP (p-value=0.014). Statistical significant difference was present at 1 month follow up with higher scores in TAPP (p-value=0.011). At 3 and 6 months, no statistical difference was found in the scores.
Conclusions: Present study demonstrates a significant advantage of TEP over TAPP up to 1-month follow-up, in terms of post-operative QOL. Choosing a superior laparoscopic method between TEP and TAPP requires high powered RCTs with long term follow up to assess the technical advantages and post-operative complications along with post-operative quality of life in patients.
References
Primatesta P, Goldacre MJ. At Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25:835-9
Malangoni MA, Rosen MJ. Hernias. In: M.Townsend, R. Daniel Beauchamp, B. Mark Evers, Kenneth L. Mattox eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia: Saunders; 2013:1114-38.
Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg. 2009;249:33-8.
Köckerling F, Bittner R, Kofler M, Mayer F, Adolf D, Kuthe A, Weyhe D. Lichtenstein versus total extraperitoneal patch plasty versus transabdominal patch plasty technique for primary unilateral inguinal hernia repair: a registry-based, propensity score-matched comparison of 57,906 patients. Ann Surg. 2017.
Lawrence K, McWhinnie D, Jenkinson C, Coulter A. Quality of life in patients undergoing inguinal hernia repair. Annals of Royal College Surg Eng. 1997;79(1):40-5.
Belyansky I, Tsirline VB, Klima DA, Walters AL, Lincourt AE, Heniford TB. Prospective, comparative study of postoperative quality of life in TEP, TAPP, and modified Lichtenstein repairs. Ann Surg. 2011;254(5):709-14;
Krishna A, Misra MC, Bansal VK, Kumar S, Rajeshwari S, Chabra A. et al. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc. 2012;26(3):639-49.
Muysoms FE, Vanlander A, Ceulemans R, Kyle-Leinhase I, Michiels M, Jacobs I, Pletinckx P, Berrevoet F. A prospective, multicenter, observational study on quality of life after laparoscopic inguinal hernia repair with ProGrip laparoscopic, self-fixating mesh according to the European Registry for Abdominal Wall Hernias Quality of Life Instrument. Surg. 2016;160(5):1344-57.
Khullar R. Clinical and postoperative outcomes of laparoscopic groin hernia repair. Ann Laparosc Endosc Surg. 2017;2:103.
Köckerling F, Bittner R, Jacob DA, et al .TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endosc. 2015;29(12):3750-60.
Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc. 2012;26(12):3355-66.
Vãrcuæ F, Duåã C, Dobrescu A, Lazãr F, Papurica M, Tarta C. Laparoscopic Repair of Inguinal Hernia TEP versus TAPP. Chirurgia (Bucur). 2016;111(4):308-12.
Rambhia SU, Modi R. A comparative study between totally extraperitoneal and transabdominal preperitoneal laparoscopic inguinal hernia repair techniques. Int Surg J. 2017;4:663-70.
Verma N, Prajapati K and Mistry S: A comparative study between total extraperitoneal (TEP) repair and Transabdominal pre-peritoneal (TAPP) repair in management of inguinal hernia. Nat J of Med Res, 2015;5:64-6
Sharma VK, Chandel UK, Thakur D, Jaswal KJS, Jhobta RS. TEP versus TAPP Repair for Inguinal Hernia- A Prospective Study in a Tertiary Care Centre (IGMC Shimla). J Med Sci Clinic Res.2017;5(1)
Krishnasamy R, Karuppaiah IM. Comparative study between postoperative outcome of transabdominal preperitoneal repair vs totally extraperitoneal repair for ingunal hernia repair. Global J Res Analy. 2017;6(9)
Bansal VK, Krishna A, Manek P et al.A prospective randomized comparison of testicular functions, sexual functions and quality of life following laparoscopic totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) inguinal hernia repairs. Surg Endosc. 2017;31(3):1478-1486.
Papachristou EA, Mitselou MF, Finokaliotis ND.Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair. Hernia. 2002;6(2):68-72.
.Zanghì A, Di Vita M, Lo Menzo E et al. Multicentric evaluation by Verbal Rate Scale and EuroQoL-5D of early and late post-operative pain after TAPP and TEP procedures with mechanical fixation for bilateral inguinal hernias. Ann Ital Chir. 2011;82(6):437-42.
Sharma D, Yadav K, Hazrah P et al. Prospective randomized trial comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic totally extra peritoneal (TEP) approach for bilateral inguinal hernias. Int J Surg. 2015;22:110-7.
