Efficacy of laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair in the treatment of bilateral inguinal hernia: a systematic review and meta-analysis

Abstract

Inguinal hernia is a common general-surgical disease. Laparoscopic repair is widely used for bilateral cases. The practical trade-offs between laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair remain debated, and most existing publications focus on unilateral inguinal hernia. We searched multiple domestic and international databases for comparative studies of TAPP versus TEP for bilateral inguinal hernia. Literature retrieval covered records from database inception to April 6, 2026. Evaluated outcomes included general complications, special complications, recurrence, postoperative pain, operative time, and length of hospital stay. Statistical analyses were performed with RevMan 5.3 and Stata 18. Nine eligible studies involving 1,319 patients were included (846 patients in the TAPP group and 473 in the TEP group). Pooled data show no significant between-group differences for general complications, special complications, postoperative pain, operative time, and length of hospital stay (all P  > 0.05). The overall pooled result indicated a trend toward lower short-term recurrence with TAPP, which was largely driven by retrospective non-randomized cohort data. Although the RCT subgroup yielded a borderline nominally significant result, this signal derived from very limited trial data and does not establish a genuine between-group difference in recurrence risk. Given the maximum follow-up of 12 months across eligible studies, this recurrence-related finding warrants cautious interpretation. TAPP and TEP deliver comparable short-term safety and efficacy for bilateral inguinal hernia repair. The observed trend of lower short-term recurrence for TAPP relies heavily on observational cohort data and receives no support from RCT evidence. We cannot draw definitive conclusions about recurrence benefits. Further large-sample, long-term high-quality studies are needed.