LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR VS LICHTENSTEIN REPAIR FOR ADULT INGUINAL HERNIAS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS jeremiahdanielmd@gmail.com

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LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR VS LICHTENSTEIN REPAIR FOR ADULT INGUINAL HERNIAS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

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Afsheen Khan k.afsheen202@gmail.com Dow University of Health Science Department of Medicine Karachi Pakistan

Muhammad Hamza muhammadhamza222000@gmail.com Saidu Medical College Department of Medicine Swat Pakistan

Mohammedsadeq A. Shweliya mohammedsadiq19994@gmail.com University of Baghdad College of Medicine Department of Medicine Baghdad Iraq

 

Nigeria

Oral or Poster

The optimal approach for adult inguinal hernia repair remains debated, with conflicting evidence from prior meta-analyses regarding pain, return-to-work, and patient subgroups. We performed the largest meta-analysis to date, synthesizing 34 randomized controlled trials (RCTs) to compare laparoscopic transabdominal preperitoneal (TAPP) and open Lichtenstein repair (OLR).

Following PRISMA 2020 guidelines, we systematically searched PubMed, Web of Science, the Cochrane Library, and ClinicalTrials.gov from inception till May 2025. Eligible studies were RCTs directly comparing TAPP and OLR. Two reviewers independently performed data extraction and risk of bias assessment, with resolution by a third. Meta-analysis used random-effects models in R. Prespecified subgroup analyses addressed primary versus recurrent and unilateral versus bilateral hernias. Evidence certainty was graded with the GRADE framework.

TAPP significantly reduced early postoperative pain (day 0: MD −1.61, 95% CI −2.47 to −0.75; day 1: MD −1.06, 95% CI −1.70 to −0.43; 1 week: MD −1.01, 95% CI −1.71 to −0.31). Patients undergoing TAPP returned to normal activities sooner (MD −3.03 days, 95% CI −5.67 to −0.40). No significant differences were observed in length of stay (MD −0.28 days, 95% CI −0.83 to 0.26) or analgesic use (MD −2.06 tablets, 95% CI −6.02 to 1.90). Between-study heterogeneity was high (I² >90% for several outcomes), though sensitivity analyses and funnel plots supported overall robustness.

TAPP provides consistent early pain reduction and faster functional recovery, unlike OLR, particularly for recurrent and bilateral cases. These findings support the selective adoption of TAPP guided by patient preference, surgeon expertise, and resources available.