Laparoscopic Total Extra-Peritoneal (TEP) Inguinal Hernia Repair
Laparoscopic total extra-peritoneal inguinal hernia repair (TEP-IHR) results in similar recurrence rates to an open, tension-free repair with improved post-operative pain. However, there is a steep learning curve with TEP-IHR which requires a robust knowledge of pre-peritoneal inguinal anatomy. TEP-IHR may be used for primary inguinal hernias but also is an excellent option for a recurrent inguinal hernia following an open repair or for bilateral inguinal hernias. An open approach may be technically easier for chronically incarcerated and scrotal hernias compared to TEP-IHR. The technical pearls of the operation include creation of the pre-peritoneal space with a dissecting balloon which maximizes exposure and minimizes bleeding and peritoneal penetration. Further, the affected side should be assessed in a systematic way to fully appreciate for a direct, femoral, and indirect hernia with placement of a prosthetic, lightweight mesh that covers all of these potential spaces. Finally, the contralateral side can be inspected with modest dissection to determine if an occult hernia is present and repaired at the same time.
KeywordsExtra-peritoneal Laparoscopic Cooper’s ligament Indirect inguinal hernia Direct inguinal hernia Femoral hernia Ilioinguinal nerve Transversalis fascia Vas deferens Spermatic cord
Laparoscopic TEP inguinal repair, by Jacob (MOV 595,438 kb)
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