Comparison of clinical effects of TEP,TAPP,and Lichtenstein procedures for adult inguinal hernia

Yang Min; Zhou Huipeng; Cui Ying; Jiang Na; Liu Dawei; Chai Zhenlong; Zhang Haiyang; Li Jing

doi:10.11986/j.issn.1673-873X.2025.06.06

Abstract：Objective To compare the effects of totally extraperitoneal repair(TEP),transabdominal preperitoneal repair(TAPP),and open Lichtenstein tension-free repair for adult inguinal hernia,and to evaluate their impacts on postoperative inflammatory markers and recurrence.Methods From June 2021 to May 2024,148 adult patients with inguinal hernia ad-mitted to the 964th Hospital of Joint Logistics Support Force were enrolled.According to the surgical method,patients were assigned to the TEP group(n=53),the TAPP group(n=50),or the Lichtenstein group(n=45).The TEP group under-went TEP;the TAPP group,TAPP;and the Lichtenstein group,the Lichtenstein procedure.Intraoperative blood loss,time of operation,time to ambulation after surgery,time to oral intake after surgery,and length of hospital stay were com-pared among the three groups.Postoperative complications were recorded.Pain was assessed using the visual analogue scale(VAS)preoperatively and at 12 and 24 hours postoperatively.Procalcitonin(PCT),C-reactive protein(CRP),cortisol(Cor),and norepinephrine(NE)were measured preoperatively and at 2 days postoperatively.Recurrence was assessed at 6 months of follow-up.Results Intraoperative blood loss in the TAPP and TEP groups was less than in the Lichtenstein group,and time of operation,time to ambulation,time to oral intake,and length of hospital stay were shorter in the TAPP and TEP groups than in the Lichtenstein group,with statistically significant differences(P＜0.05).The TEP group had significantly less intraoperative blood loss than the TAPP group,and shorter time to postoperative first eating,and length of hospital stay than the TAPP group(P＜0.05).The incidence of complications in the TAPP and TEP groups was signifi-cantly lower than that in the Lichtenstein group(P＜0.05).Compared with preoperative values,VAS scores at 12 and 24 hours after surgery decreased significantly in all three groups(P＜0.05);at 12 and 24 hours postoperatively,VAS scores in the TAPP and TEP groups were significantly lower than those in the Lichtenstein group(P＜0.05),and VAS scores in the TEP group were significantly lower than those in the TAPP group(P＜0.05).At postoperative day 2,PCT and CRP levels in all three groups were significantly higher than preoperative levels(P＜0.05);PCT and CRP in the TAPP and TEP groups were significantly lower than those in the Lichtenstein group(P＜0.05),and PCT and CRP in the TEP group were significantly lower than those in the TAPP group(P＜0.05).At postoperative day 2,Cor and NE levels in all three groups were higher than preoperative levels(P＜0.05);Cor and NE in the TAPP and TEP groups were lower than those in the Li-chtenstein group(P＜0.05),and Cor and NE in the TEP group were lower than those in the TAPP group(P＜0.05),with differences being statistically significant.Conclusion For adult inguinal hernia,TEP and TAPP,compared with the Lichtenstein procedure,can significantly reduce postoperative complication rates,decrease intraoperative blood loss,shorten postoperative recovery time,and attenuate postoperative inflammatory and stress responses.Furthermore,because TEP does not enter the peritoneal cavity,it has a safety advantage over TAPP.The surgical approach should be chosen according to the patient's individual circumstances.