Laparoscopic totally extraperitoneal (TEP) versus transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernia repair: a systematic review and meta-analysis.

BACKGROUND: The optimal laparoscopic approach for bilateral inguinal hernia repair is unclear. The 2 primary methods are totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches. We conducted a systematic review and meta-analysis to compare surgical outcomes of TEP and TAPP for bilateral inguinal hernia repair. METHODS: PubMed, EMBASE, and CENTRAL databases were searched through April 15, 2025. Studies comparing TEP and TAPP in adults with bilateral inguinal hernias were included. Outcomes assessed included hernia recurrence, pain scores, length of hospital stay (LOS), operation time, return to activities of daily living, and complications. Odds ratios (ORs) and standardized mean differences (SMDs) were pooled using fixed or random effects models. RESULTS: Three randomized controlled trials (RCTs) and 4 retrospective studies with a total of 1164 patients were included in the analysis. Hernia recurrence was significantly lower with TAPP compared to TEP (pooled OR 0.27, 95% confidence interval [CI] 0.11-0.67; I2 = 8.2%). No significant differences were observed in 24-h pain score (SMD = - 0.96, 95% CI - 4.36 to 2.44), 7-day pain score (SMD = - 4.60, 95% CI - 53.77 to 44.56), LOS (SMD = 0.00, 95% CI - 0.79 to 0.79), or operation time (SMD = - 0.84, 95% CI - 3.44 to 1.75). Return to activities of daily living favored TAPP (SMD = - 0.53, 95% CI - 0.97 to - 0.09). Complications including seromas, wound infections, and urinary retention did not significantly differ between groups. CONCLUSIONS: TAPP is associated with lower recurrence risk and earlier recovery compared to TEP. Further large-scale, high-quality trials are needed to validate these findings.