Laparoscopic groin hernia repair, trans abdomino preperitoneal choice: techniques and results

Introduced in 1992, the aim of laparoscopy was to reproduce the Stoppa procedure. TAPP (trans abdomino preperitoneal), in opposite of TEP (totally extraperitoneal), led to put a mesh between pubic tubercle and anteriosuperior iliac spine, through intaperitoneal way, with incision of peritoneal sheet up to the hernia, reintegration of the sac and then, closure of the peritoneal sheet to protect viscera from prosthetic material. The results of more than sixty prospective randomised trials and ten meta-analysis show that laparoscopic cures, among all procedures of hernia repair, are the surgical techniques which are the less painful in short and long term and allow the most early back to activity. They need general anaesthesia. Postoperative complications (very rare, but which could be very severe) and recurrence rate depend of learning curve. Today, no difference could be shown between TAPP and TEP. Nevertheless, TAPP use a larger space of work and allows more complex repairs: big hernias, recurrences after first repair with mesh. It has not be demonstrated that laparoscopy is more expensive than other techniques, when global cost is assessed.