Risk of reoperation after TEP, TAPP, and Lichtenstein repair for primary groin hernia: a register-based cohort study across two nations

PURPOSE: Annually, more than 24,000 groin hernia repairs are performed in Sweden and Denmark, approximately 12,000 of which are laparoscopic like totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repairs. TEP is the preferred technique in Sweden, whereas TAPP is preferred in Denmark. This study aimed to assess the risk of reoperation for recurrence following TAPP, TEP, and Lichtenstein techniques.

METHOD: Prospectively collected data from the Danish Hernia Database and the Swedish Hernia Register were utilized for this observational register-based study. Primary groin hernia repairs utilizing TEP, TAPP, or Lichtenstein techniques between 2004 and 2020 were included. The primary outcome was the reoperation rate for recurrence analyzed using both crude reoperation rates and Cox proportional hazard regression analysis.

RESULTS: During 17 years, 347,912 primary groin hernia repairs were performed, of which 12% were TEP, 15% TAPP, and 74% Lichtenstein repairs. In males, the risk of reoperation was higher after TEP than after TAPP (HR 1.38, 95% CI 1.27-1.5) and Lichtenstein (HR 1.44, 95% CI 1.36-1.53). In females, Lichtenstein repair had a higher risk than the laparoscopic approaches, with no significant difference between TAPP and TEP.

CONCLUSION: Our study demonstrated low rates of reoperation for recurrence after Lichtenstein, TEP, and TAPP repairs. In men, TEP repair is associated with an increased risk of reoperation for recurrence compared with Lichtenstein and TAPP repair. For females, the laparoscopic approaches were superior to the Lichtenstein repair. These findings emphasize the importance of international comparative studies to optimize hernia management strategies.