Trends, case selection and comparative outcomes of e-TEP with TAPP and TEP for groin hernia - data from Indian hernia collaborative.

Abstract

<h4>Introduction</h4>There is an increasing adoption of e-TEP technique for inguinal hernia repair. However, there remains a lack of clarity regarding the criteria for selecting this technique and whether it leads to better clinical outcomes compared to standard laparoscopic methods. To address this gap, the present study analyzed data from the Indian Hernia Collaborative-a multicenter initiative of the Hernia Society of India (HSI) launched in 2022. The study aimed to assess the patterns of case selection and outcomes associated with e-TEP in comparison to TEP and TAPP.<h4>Methods</h4>The datasets were collected from 26 centres using a pre-designed Excel sheet. Each dataset included one-year follow-up data for all patients. A comparative analysis was conducted for patients who underwent laparoscopic groin hernia repair using one of three techniques: enhanced-view totally extraperitoneal (eTEP), transabdominal preperitoneal (TAPP), or totally extraperitoneal (TEP) repair.<h4>Results</h4>Of the 1,510 patients, 992 underwent laparoscopic groin hernia repair and the rest were open surgeries. Among them, 537 patients had bilateral repairs, resulting in a total of 1,529 individual laparoscopic procedures. The distribution of techniques was as follows: TAPP in 489 (49.3%), TEP in 489 (27.9%), and enhanced-view eTEP in 226 (22.8%) of cases. TAPP was more commonly selected for irreducible hernias. The eTEP technique was more often utilized in larger hernias (W3), compared to TEP. Mesh fixation was significantly more frequent in the TAPP group (97.7%) compared to the eTEP (86.7%) and TEP (38.2%) groups. Plication of the hernia sac was commonly performed in TAPP (20.2%), followed by TEP (5.85%) and e-TEP (2.38%), with the differences being statistically significant (p < 0.001). However, the operative duration was significantly longer for eTEP (87.3 min) and TAPP (94.1 min) than for TEP (70.2 min). Seroma, surgical site infection, hematoma, postoperative pain and recurrence rates were comparable across all three techniques.<h4>Conclusion</h4>In India, eTEP has seen a rapid rise in adoption amongst TEP surgeons and is increasingly being utilized for larger and more complex groin hernia repairs, however, there is no difference in short-term outcomes between the three procedures.