Abstract
Purpose
Major innovations continue to occur in the operative techniques used in hernia operations. Laparoscopic totally extra-peritoneal (TEP) hernia repair is the latest addition to the long list of operations used for hernia repair. The objectives of this study were to assess the safety and efficacy of this relatively new procedure and to discuss various technical aspects to make the procedure easy to learn.
Methods
Patients who underwent elective inguinal hernia repair from January 2000 to December 2008 were included in this ongoing prospective clinical study. Patient demographic data, operative records, perioperative findings, postoperative morbidity and outpatient follow-up of TEP repairs were studied.
Results
Out of 1,814 hernia operations, 1,539 (84.84%) were performed by laparoscopic TEP repair and 275(15.16%) were operated by Lichtenstein repair. There were 19 conversions from attempted TEP to open surgeries. Mean operative time for unilateral TEP repair was 28 ± 7 min and for bilateral repair 36 ± 8 min The incidence of intra-operative complications was 2.98%. Overall morbidity rate was 8.57%. The usual hospital stay was 36 h. The recurrence rate in first 3 years was 8.00%, the next 3 years, 2.05% and in the last 3 years, 0.67%. The longest interval between operation and recurrence was 48 months.
Conclusions
Laparoscopic TEP repair is an excellent mode of treatment in the era of laparoscopic surgery. If the standard technique now established is followed, the procedure is easy to learn for a laparoscopic surgeon, the overall morbidity and complications are fewer in number and severity, and recurrence rates are lower.
Similar content being viewed by others
References
Read RC (1984) The development of inguinal herniorhhaphy. Surg Clin North Am 64:185–196
Bassini E (1887) Sulla cura radicle dell’erinea inguinale. Arch Soc Ital Chir 4:380
Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193
Dulucq JL (1991) Traitement des hernies de l’aine par la mise en place d’un patch prothetiquepar laparoscopi. Voe totalement extraperitoneale. Cah Chir 79:15–16
Jagdish N, Sameer R, Omprakash R (2002) Port-site tuberculosis: a rare complication following laparoscopic cholecystectomy. Scand J Infect Dis 34(12):928–929
Rutkow IM (1998) Epidemiology, economic and sociologic aspects of hernia surgery in the 1990s. Surg Clin North Am 73:413–426
Fitzgibbons RJ, Camps J, Cornet DA et al (1995) Laparoscopic inguinal hernorrhaphy: results of a multicenter trial. Ann Surg 221:3–13
Nathan JD, Pappas TN (2003) Inguinal hernia: an old condition with new solutions. Ann Surg 238:S148–S157
Swanstron LL (2000) Laparoscopic hernia repairs: the importance of cost as an outcome measurement at the century’s end. Surg Clin North Am 80:1341–1351
Camps J, Nguyen N, Annabali R et al (1995) Laparoscopic inguinal herniorrhaphy: transabdominal techniques. Int Surg 80:18–25
Felix EL, Michas CA, Gonzalez MH Jr (1995) Laparoscopic hernioplasty: TAPP vs TEP. Surg Endosc 9:984–989
Dulucq JL (2000) Pre-peritoneal approach in laparoscopic treatment of inguinal hernia. J Chir 137(5):285–288
Bowne WB, Morgenthal CB, Castro AE et al (2007) The role of endoscopic extraperitoneal herniorrhaphy: Where do we stand in 2005? Surg Endosc 21:707–712
McCormack K, Scott NW, Go PM et al (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003:CD001785
Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal(TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 25(1):CD004703
Bhandarkar DS, Shankar M, Udwadia TE (2006) Laparoscopic surgery for inguinal hernia: current status and controversies. J Min Access Surg 2:178–186
Langeveld HR, Riet M, Weidema WF et al (2010) Extraperitoneal inguinal hernia repair compared with lichtenstein (the LEVEL-trial). Ann Surg 251:819–824
Pokorny H, Klingler A, Schmid T et al (2007) Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 12:385–389
Bringman S, Ramel S, Heikkinen TJ et al (2003) Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial. Ann Surg 237:142–147
Dulucq JL, Wintringer P, Mahajana A (2009) Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years. Surg Endosc 23:482–486
Misra MC, Kumar S, Bansal VK (2008) Total extraperitoneal (TEP) mesh repair of inguinal hernia in the developing world: comparison of low-cost indigenous balloon dissection versus direct telescopic dissection: a prespective randomized controlled study. Surg Endosc 22:1947–1958
Bittner R, Sauerland S, Schmedt C-G (2005) Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair. Surg Endosc 19:605–615
Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair. Surg Endosc 19:188–199
Felix EL, Herbertson N, Vartanian S (1999) Laparoscopic hernioplasty significant complications. Surg Endosc 13:328–331
Ramshaw B, Wo Shuler F, Jones HB, Duncan TD, White J, Wilson R, Wo Lucas G, Mason EM (2001) Laparoscopic inguinal herna repair. Lessons learned after 1,224 consecutive cases. Surg Endosc 15:50–54
Beets GL, Oosterhuis KJ, Go PMNYH, Baeten CGMI, Kootstra G (1997) Long-term follow-up (12–15 years) of a randomized controlled trial comparing Bassini-Stetten, Shouldice, and high ligation with narrowing of the internal ring for primary inguinal hernia repair. J Am Coll Surg 185:352–357
Phillips EH, Carroll BJ, Fallas MJ (1993) Laparoscopic preperitoneal inguinal hernia repair without peritoneal incision. Surg Endosc 7:159–162
Voeller GR, Mangimate EC Jr, Wilson C (1995) Totally preperitoneal laparoscopic inguinal herniorrhaphy using balloon dissection. Surg Rounds 3:107–112
Bringman S, Ek A, Haglind E, Heikkinnen T, Kald A, Kylberg F, Ramel S, Wallon C, Anderberg B (2001) Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty(TEP)? Surg Endosc 15:266–270
Acknowledgments
The author wishes to place on record his gratitude to Dr. (Mrs.) V.N. Swadia for help in preparation of the manuscript.
Conflict of interest
The author declares that he has no conflict of interest regarding this study.
Author information
Authors and Affiliations
Corresponding author
Additional information
N.D.S. hereby declares that the study complies with the current laws of integrity and ethical standards of India in which the study was conducted.
Rights and permissions
About this article
Cite this article
Swadia, N.D. Laparoscopic totally extra-peritoneal inguinal hernia repair: 9 year’s experience. Hernia 15, 273–279 (2011). https://doi.org/10.1007/s10029-010-0781-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-010-0781-x