Ambulatory Tapp Versus Tep for Groin Hernia in Women: A Randomized Clinical Trial

Groin hernia in women is understudied. Minimal invasive techniques may be preferred because of the female higher rate of femoral hernia, often overlooked with open techniques. To date, there are no studies comparing laparoendoscopic techniques in women. A randomized controlled trial is conducted between 2019 and 2023. Women over 18 with primary groin hernia are randomly assigned to ambulatory TAPP or TEP approach. The main objective is to compare hospital postoperative length of stay. The secondary objective is to evaluate discharge pain, and chronic postoperative inguinal pain (CPIP) during the first postoperative year. Recurrence and adverse events are calculated. 78 patients are recruited, 39 for each group. 2 patients are excluded. Median postoperative stay is 360 minutes for TAPP group and 300 minutes for TEP group (p < 0.001). Globally, median pain at discharge is 3.5 without differences between techniques. Postoperative length of stay is related to pain at discharge (ρ = 0.268, p = 0.021), increasing intensity with bilateral repair (ρ = 1.223, p = 0.002) or usage of tacks (ρ = 1.833, p = 0.034). Incidence of CPIP is 14,8% one year after surgery (n = 61; TAPP 12,5%, TEP 17,2%, p = 0,724). CPIP limits daily life at the third month (p = 0,040), but not at the one-year follow-up. Radiological recurrence rate is 7,9% at the one-year follow-up (TAPP 11,4%, TEP 3,6%, p = 0,371). No relevant adverse events are registered. Ambulatory laparoendoscopic surgery is feasible and safe for female groin hernia. The TEP approach implies less median hospital stay, although not clinically relevant. CPIP affects daily-life activities in the early postoperative, but wanes at the one-year follow-up.