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

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).

Conclusions: 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.