Hernia Surgery pp 461-466 | Cite as

Laparoscopic Total Extra-Peritoneal (TEP) Inguinal Hernia Repair

  • Tammy KindelEmail author
  • Dmitry Oleynikov


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.


Extra-peritoneal Laparoscopic Cooper’s ligament Indirect inguinal hernia Direct inguinal hernia Femoral hernia Ilioinguinal nerve Transversalis fascia Vas deferens Spermatic cord 

Supplementary material

Video 44.1

Laparoscopic TEP inguinal repair, by Jacob (MOV 595,438 kb)


  1. 1.
    Heikkinen TJ, Haukipuro K, Koivukangas P, Hulkko A. A prospective randomized outcome and cost comparison of totally extra-peritoneal endoscopic hernioplasty versus Lichtenstein operation among employed patients. Surg Laprosc Endosc. 1998;8:338–44.CrossRefGoogle Scholar
  2. 2.
    Pawanindra L, Kajla RK, Chander J, et al. Randomized controlled study of laparoscopic total extra-peritoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc. 2003;17:850–6.CrossRefGoogle Scholar
  3. 3.
    Bochkarev V, Ringley C, Vitamvas M, Oleynikov D. Bilateral laparoscopic inguinal hernia repair in patients with occult contralateral inguinal defects. Surg Endosc. 2007;21(5):734–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350:1819–27.CrossRefPubMedGoogle Scholar
  5. 5.
    Pokorny H, Klingler A, Schmid T, et al. Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia. 2008;12:385–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Koning GG, Wettersley J, van Laarhoven CJ, Keus F. The totally extraperitoneal method versus Lichtenstein’s technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS One. 2013;8:e52599.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Aigner F, Augustin F, Kaufmann C, Schlager A, Ulmer H, Pratschke J, Schmid T. Prospective, randomized-controlled trial comparing postoperative pain after plug and patch open repair with totally extraperitoneal inguinal hernia repair. Hernia. 2014;18(2):237–42.CrossRefPubMedGoogle Scholar
  8. 8.
    Eklund A, Montgomery A, Bergkvist L, Rudberg C, et al. Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg. 2010;97(4):600–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Bracale U, Melillo P, Pignata G, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc. 2012;26:3355–66.CrossRefPubMedGoogle Scholar
  10. 10.
    Gass M, Banz VM, Rosella L, et al. TAPP or TEP? Population-based analysis of prospective data on 4,552 patients undergoing endoscopic inguinal hernia repair. World J Surg. 2012;36:2782–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Eker HH, Langeveld HR, Klitsie PJ, et al. Randomized clinical trial of total extraperitoneal inguinal hernioplasty vs Lichtenstein repair: a long-term follow-up study. Arch Surg. 2012;147:256–60.CrossRefPubMedGoogle Scholar
  12. 12.
    DeTurris SV, Cacchione RN, Mungara A, et al. Laparoscopic herniorrhaphy: beyond the learning curve. J Am Coll Surg. 2002;194:65–73.CrossRefPubMedGoogle Scholar
  13. 13.
    Pawanindra L, Kajla RK, Chander J, Ramteke VK. Laparoscopic total extraperitoneal (TEP) inguinal hernia repair: overcoming the learning curve. Surg Endosc. 2004;18:642–5.CrossRefGoogle Scholar
  14. 14.
    Schouten N, Simmermacher RKJ, van Dalen T, et al. Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair? Surg Endosc. 2013;27:789–94.CrossRefPubMedGoogle Scholar
  15. 15.
    Kurashima Y, Feldman LS, Kaneva PA, et al. Simulation-based training improves the operative performance of totally extraperitoneal (TEP) laparoscopic inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc. 2014;28:783–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Schouten N, Elshof JWM, Simmermacher RKJ, et al. Selecting patients during the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair. Hernia. 2013;17:737–43.CrossRefPubMedGoogle Scholar
  17. 17.
    Ferzli G, Kiel T. The role of the endoscopic extraperitoneal approach in large inguinal scrotal hernias. Surg Endosc. 1997;11(3):299–302.CrossRefPubMedGoogle Scholar
  18. 18.
    Ferzli G, Shapiro K, Chaudry G, Patel S. Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia. Surg Endosc. 2004;18:228–31.CrossRefPubMedGoogle Scholar
  19. 19.
    Dulucq JL, Wintringer P, Mahajna A. Totally extraperitoneal (TEP) hernia repair after radical prostatectomy or previous lower abdominal surgery: is it safe? A prospective study. Surg Endosc. 2006;20(3):473–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Nebraska Medical CenterOmahaUSA

Personalised recommendations