If you have been told you need surgery for a groin hernia, you may have heard the terms TEP and TAPP. Both are laparoscopic (keyhole) operations that repair the hernia with a mesh. This article explains in plain language how the two differ, who each one suits and what recovery is like.
What is an inguinal hernia?
An inguinal hernia is a bulge in the groin that appears when fat or a loop of bowel pushes through a weak spot in the abdominal wall. It often becomes more obvious on standing, coughing or lifting, and may cause a dragging discomfort. A hernia does not heal by itself and tends to grow over time. Surgery is the only lasting treatment.
How laparoscopic hernia repair works
The surgeon works through three small cuts with a camera and fine instruments. The bulge is returned to its place and a soft mesh is laid behind the weak area, on the inside of the abdominal wall. The body grows into the mesh, which strengthens the wall. Read more about laparoscopic hernia surgery.
What is TEP repair?
TEP means totally extraperitoneal repair. The surgeon creates a working space between the abdominal muscles and the thin inner lining of the abdomen (the peritoneum). The abdominal cavity itself is never entered, so the instruments stay away from the bowel.
What is TAPP repair?
TAPP means transabdominal preperitoneal repair. The surgeon enters the abdominal cavity, opens the inner lining over the hernia, places the mesh behind it and then closes the lining again. This approach gives a wide view of both groins and of the hernia contents.
TEP vs TAPP: the main differences
| TEP | TAPP | |
|---|---|---|
| Route | Stays outside the abdominal cavity | Goes through the abdominal cavity |
| View | Narrower working space | Wide view of both sides |
| Often chosen for | Straightforward hernias on one or both sides | Large, complex or recurrent hernias, or when the diagnosis is uncertain |
| Mesh | Yes | Yes |
| Anaesthesia | General | General |
Which one is better?
Neither is better for every patient. Studies show similar results for pain, recovery and the chance of the hernia returning when the operation is done by an experienced surgeon. The choice depends on the size and type of hernia, whether it is on one side or both, any earlier surgery in the lower abdomen and the surgeon’s judgement.
Who may not be suitable for keyhole repair?
An open repair may be advised for patients who cannot safely have a general anaesthetic, for some very large hernias, or after certain earlier operations. This is decided at the consultation.
Recovery after TEP or TAPP
- Most patients walk on the day of surgery and many go home within a day
- Light activity and desk work are usually possible within a few days
- Avoid heavy lifting and strenuous exercise until your surgeon allows it
- Some bruising or swelling in the groin is common and settles over a few weeks
Possible risks
Complications are uncommon but include a collection of fluid or blood at the site, infection, difficulty passing urine for a short time, lasting groin pain and return of the hernia. Your surgeon will explain these before the operation.
Frequently asked questions
Can both sides be repaired at the same time?
Yes. A hernia on both sides can be repaired through the same small cuts, which is one of the advantages of keyhole repair.
Is the mesh safe?
Mesh has been used in hernia repair for many years and lowers the chance of the hernia coming back. Problems related to mesh are uncommon.
Can a hernia be treated without surgery?
No medicine or belt cures a hernia. A support may ease discomfort for a time, but only surgery repairs the weakness.
To have your hernia assessed by Dr. Fayem Chowdhury Sony, request an appointment.
This article is for general awareness and does not replace a consultation with a doctor.