LAPAROSCOPIC INGUINAL HERNIA REPAIR IN OBESE PATIENTS: IS TEP SUPERIOR TO TAPP?

Background: Laparoscopic inguinal hernia repair offers significant advantages for obese patients, but debate persists regarding the optimal approach between Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) techniques. This study aims to compare perioperative outcomes, complications, and quality of life in obese patients undergoing TEP versus TAPP inguinal hernia repair. Methods: This prospective randomized study was conducted at JK Hospital, Bhopal, between June 2023 and January 2024. Thirty obese patients (BMI ≥30 kg/m²) with inguinal hernias were randomized into TEP (n=15) or TAPP (n=15) groups. Primary outcomes included operative time, technical feasibility, conversion rate, and perioperative complications. Secondary outcomes were postoperative pain, hospital stay, return to activities, chronic pain, and recurrence at 6-month follow-up. Results: Both groups were comparable in terms of demographic characteristics and hernia types. Mean operative time was shorter in the TAPP group (65.7±12.3 min vs. 78.3±14.8 min, p=0.017). Peritoneal breaches occurred in 4 (26.7%) TEP cases. Conversion to open repair was required in 1 (6.7%) TEP case and none in the TAPP group. Postoperative pain scores at 24 hours were similar (VAS 3.8±1.1 vs. 3.7±1.2, p=0.802), as was hospital stay (1.3±0.5 vs. 1.5±0.6 days, p=0.334). Seroma formation was higher in the TAPP group (20% vs. 13.3%, p=0.624). At 6-month follow-up, chronic pain was reported in 1 (6.7%) TEP patient and 2 (13.3%) TAPP patients. No recurrences were observed in either group.Conclusion: In obese patients, TAPP offers advantages of shorter operative time and lower technical complexity, while TEP demonstrates a trend toward fewer access-related complications. Both approaches provide comparable postoperative outcomes and patient satisfaction. The choice between TEP and TAPP in obese patients should consider surgeon experience, patient characteristics, and individual risk factors.