Efficacy of totally extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review and meta-analysis.

IF 2.4 2区医学 Q1 SURGERY Hernia Pub Date : 2025-04-01 DOI:10.1007/s10029-025-03322-x

María Alejandra Romero-Silva, Jose Caballero-Alvarado, Carlos Zavaleta-Corvera

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Abstract

Objective: To evaluate the efficacy and safety of totally extraperitoneal endoscopic hernioplasty (TEP) compared to the Lichtenstein hernioplasty in adult patients with uncomplicated inguinal hernia.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. We included 27 randomized controlled trials (RCTs) identified through comprehensive searches in Embase, Web of Science, PubMed, Scopus, and Cochrane Library. Studies comparing TEP and Lichtenstein techniques in adult patients with uncomplicated inguinal hernias were selected. Primary outcomes included hernia recurrence and chronic postoperative pain. Secondary outcomes assessed were surgical wound infection, seroma, hematoma, scrotal edema, operative time, hospital stay (in hours and days), and time to return to daily activities.

Results: A total of 27 RCTs with 7,658 patients were analyzed. No significant difference was found in hernia recurrence between TEP and Lichtenstein (RR 1.03; 95% CI [0.62-1.72]; p = 0.90). However, TEP significantly reduced the risk of chronic postoperative pain by 62% (RR 0.38; 95% CI [0.28-0.51]; p < 0.00001), surgical wound infection by 52% (RR 0.48; 95% CI [0.31-0.75]; p = 0.001), and hematoma formation by 37% (RR 0.63; 95% CI [0.41-0.97]; p = 0.04). No significant differences were found for seroma formation (RR 1.17; 95% CI [0.98-1.40]; p = 0.08) or scrotal edema (RR 0.62; 95% CI [0.35-1.10]; p = 0.10). Operative time showed no significant difference (MD 7.78 min; 95% CI [-2.77-18.33]; p = 0.15). Regarding hospital stay, TEP reduced the duration in days (MD -0.83; 95% CI [-1.24 to -0.41]; p < 0.0001), while no difference was observed when measured in hours (MD 0.01; 95% CI [-0.29-0.31]; p = 0.95). Furthermore, TEP was associated with a faster return to daily activities by approximately 5 days (MD -4.74; 95% CI [-6.78 to -2.70]; p < 0.00001).

Conclusion: The TEP technique is more effective in terms of chronic pain, risk of surgical wound infection, and reduction of hematoma formation than the Lichtenstein technique.

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完全腹膜外内镜疝成形术（TEP）与Lichtenstein疝成形术的疗效：一项系统回顾和荟萃分析。

目的：比较全腹膜外内镜疝成形术（TEP）与Lichtenstein疝成形术治疗成人无并发症腹股沟疝的疗效和安全性。方法：根据PRISMA指南进行系统评价和荟萃分析。我们纳入了通过Embase、Web of Science、PubMed、Scopus和Cochrane图书馆综合检索确定的27项随机对照试验（RCTs）。选择比较TEP和Lichtenstein技术在成人无并发症腹股沟疝患者中的应用。主要结局包括疝气复发和术后慢性疼痛。评估的次要结局包括手术伤口感染、血肿、血肿、阴囊水肿、手术时间、住院时间（以小时和天为单位）和恢复日常活动的时间。结果：共分析了27项rct，共7658例患者。TEP与Lichtenstein患者疝复发率差异无统计学意义(RR 1.03；95% ci [0.62-1.72]；p = 0.90)。然而，TEP显著降低术后慢性疼痛风险62% (RR 0.38；95% ci [0.28-0.51]；结论：在慢性疼痛、手术伤口感染风险和减少血肿形成方面，TEP技术比Lichtenstein技术更有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.