Comparative effects of laparoscopic TAPP and TEP hernia repair on pelvic floor nerve and erectile function in male patients: a retrospective study

Background: The long-term impact of laparoscopic inguinal hernia repairs on pelvic floor nerve and erectile function in men remains unclear. This study compared the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. Methods: The data of 170 male patients with unilateral inguinal hernia who underwent surgery at our institution between June 2020 and June 2023 were retrospectively reviewed, comprising 85 cases treated with TAPP and 85 with TEP. Comparative analyses were performed for operative parameters, indices of pelvic floor nerve function, erectile function quantified by the International Index of Erectile Function-5 (IIEF-5), the incidence of (erectile dysfunction) ED, and postoperative complications. Results: The mean operative time was significantly longer in the TAPP group than in the TEP group (68.72 ± 10.66 min vs. 58.62 ± 11.84 min, p < 0.001), whereas the total hospitalization cost was higher for TEP (2.68 ± 0.48 vs. 2.40 ± 0.49 × 104 yuan, p < 0.001). At both 6 months and 1 year postoperatively, the TAPP group showed higher incidences of neuropathic pain (15.29%/10.59% vs. 5.88%/2.35%) and ED (27.06%/14.12% vs. 9.41%/4.71%) compared with the TEP group (all p < 0.05); however, these differences were no longer significant at 2 years after surgery. At 6 months postoperatively, the abnormal epididymal reflex in the TAPP group (18.82% vs. 7.06%) was significantly higher than that in the TEP group, and the difference disappeared one year after surgery. Multivariate logistic regression identified TEP as an independent protective factor against postoperative ED (odds ratio = 0.308, p = 0.020). Conclusions: Compared to TAPP, TEP repair demonstrated better early preservation of pelvic floor nerve and erectile function, likely due to less extensive dissection. Functional outcomes equalized by two years, suggesting the surgical approach should be individualized based on patient characteristics and needs.