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Randomized Controlled Trial
. 2023 Feb;27(1):119-125.
doi: 10.1007/s10029-022-02651-5. Epub 2022 Aug 4.

Transinguinal preperitoneal (TIPP) vs endoscopic total extraperitoneal (TEP) procedure in unilateral inguinal hernia repair: a randomized controlled trial

J J Posthuma  1   2 , R Sandkuyl  3 , D A Sloothaak  3 , A Ottenhof  3 , J D W van der Bilt  3   4 , J A H Gooszen  3   4 , P C M Verbeek  3 , K H In't Hof  3
Affiliations
Randomized Controlled Trial

Transinguinal preperitoneal (TIPP) vs endoscopic total extraperitoneal (TEP) procedure in unilateral inguinal hernia repair: a randomized controlled trial

J J Posthuma et al. Hernia. 2023 Feb.

Abstract

Purpose: The Lichtenstein hernioplasty has long been seen as the gold standard for inguinal hernia repair. Unfortunately, this repair is often associated with chronic pain, up to 10-35%. Therefore, several new techniques have been developed, such as the transinguinal preperitoneal patch (TIPP) and the endoscopic total extraperitoneal (TEP) technique. Several studies showed beneficial results of the TIPP and TEP compared to the Lichtenstein hernioplasty; however, little is published on the outcome when comparing the TIPP and TEP procedures. This study aimed to evaluate outcomes after the TIPP vs the TEP technique for inguinal hernia repair.

Methods: A single-center randomized controlled trial was carried out between 2015 and 2020. A total of 300 patients with unilateral inguinal hernia were enrolled and randomized to the TIPP- or TEP technique. Primary outcome was chronic pain (defined as any pain following the last 3 months) and quality of life, assessed with Carolinas comfort scale (CCS) at 12 months. Secondary outcomes were: wound infection, wound hypoesthesia, recurrence, readmission within 30 days, and reoperation.

Results: A total of 300 patients were randomized (150 per group). After a follow-up of 12 months, we observed significantly less postoperative chronic groin pain, chronic pain at exertion, wound hypoesthesia, and wound infections after the TEP when compared to the TIPP procedure. No significant differences in quality of life, reoperations, recurrence rate, and readmission within 30 days were observed.

Conclusion: We showed that the TEP has a favorable outcome compared to the TIPP procedure, leading to less postoperative pain and wound complications, whereas recurrence rates and reoperations were equal in both the groups.

Keywords: Chronic groin pain; Groin hernia; Inguinal hernia repair; Lichtenstein; TEP; TIPP.

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Conflict of interest statement

No conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart randomization and follow-up
Fig. 2
Fig. 2
Postoperative chronic pain at rest and during exertion 1 year after inguinal hernia repair by TIPP or TEP procedure. *Statistical difference between two groups
Fig. 3
Fig. 3
Distribution of pain scores after inguinal hernia repair by TIPP vs TEP
Fig. 4
Fig. 4
Wound complications after TIPP vs TEP procedure. *Statistical difference between the two groups
See this image and copyright information in PMC

Comment in

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