Hernia

https://doi.org/10.1007/s10029-023-02798-9

LETTER TO THE EDITOR

TAPP surgeons have the last laugh!

Sarfaraz Baig1 · Nidhi Khandelwal2 

Received: 10 April 2023 / Accepted: 19 April 2023

© The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2023

Dear Editor,
Since the last few decades, debates have raged in confer-
ences and surgical back alleys as to which procedure is better
for inguinal hernias—transabdominal preperitoneal repair
(TAPP) or totally extraperitoneal repair (TEP). The issues
of contention were—ergonomics, inspection of contralateral
groin, management of irreducible hernias, inadvertent peri-
toneal rent and large sac.
In addition, the consensus generally was—both are
acceptable with equally good and safe outcomes and it was
essentially left to the surgeon’s comfort [1].
This has changed in recent times. Surgeons employing
TEP technique for groin hernia discuss and publish modi-
fying port positions for complex hernias, such as large
inguinoscrotal hernias, irreducible hernias, and when the
distance from pubis to umbilicus is less [2, 3]. The rationale
is to improve the ergonomics for dissection and suturing in
these cases. Furthermore, since a future contralateral groin
exploration is not technically easy in the event of a hernia, a
prophylactic mesh in the contralateral space has been advo-
cated [4, 5].
These recent papers have exposed the limitations of TEP
in its various aspects.
Surgeons employing TAPP, on the other hand, have no
such concerns and the technique has remained constant. The
procedure, by its inherent nature allows, for contralateral
inspection, is inherently ergonomically good for suturing,
and port positions are standardised. Furthermore, the con-
tents can be reduced under vision with no dilemma of “to
cut or not to the sac” to avoid bowel injury especially in a
sliding hernia. Furthermore, robotic platforms are now rep-
licating TAPP allowing surgeons to suture with greater ease,
hereunto thought to be the disadvantage of TAPP.
The time has come to revisit the debate again, because
as of now, it looks like TAPP surgeons are having the last
laugh!
Data availability statement  There is no data associated with this
manuscript.
References
1. Felix EL, Michas CA, Gonzalez MH (1995) Laparoscopic hernio-
plasty. Surg Endosc. https://​doi.​org/​10.​1007/​bf001​88456
2. Baig SJ, Priya P, Ahuja A (2020) Modified port positions for
totally extraperitoneal (TEP) repair for groin hernias: our experi-
ence. Surg Endosc. https://​doi.​org/​10.​1007/​s00464-​020-​07620-6
3. Daes J (2012) The enhanced view—totally extraperitoneal tech-
nique for repair of inguinal hernia. Surg Endosc 26:1187–1189.
https://​doi.​org/​10.​1007/​s00464-​011-​1993-6
4. Bochkarev V, Ringley C, Vitamvas M, Oleynikov D (2007) Bilat-
eral laparoscopic inguinal hernia repair in patients with occult
contralateral inguinal defects. Surg Endosc 21(5):734–736. https://​
doi.​org/​10.​1007/​s00464-​007-​9196-x
5. Zendejas B, Onkendi EO, Brahmbhatt RD, Greenlee SM, Lohse
CM, Farley DR (2011) Contralateral metachronous inguinal her-
nias in adults: role for prophylaxis during the TEP repair. Hernia
15(4):403–408. https://​doi.​org/​10.​1007/​s10029-​011-​0784-2
Publisher's Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.

* Nidhi Khandelwal
nidhikkhandelwal@gmail.com
Sarfaraz Baig
docsarfarazbaig2@gmail.com
1
Digestive Surgery Clinic, Belle Vue Clinic, Kolkata, India
2
Jaslok Hospital and Research Centre, Mumbai, India

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