Totally Extraperitoneal (TEP) Repair (with Video)

  • David J. Berler
  • Brian P. Jacob


The minimally invasive approach to inguinal hernia repair originated with Ger and colleagues in the 1980s. Total extraperitoneal repair (TEP) depends upon the establishment of and dissection within the retrorectal space. This technique was first popularized by McKernon and Laws in 1993. The decision to proceed with TEP ultimately is multifactorial and must be individualized, with close attention to the complexity and size of the hernia, the patient’s comorbidities, and the patient’s surgical history. This chapter explores the indications and contraindications of TEP as well as the advantages and disadvantages of this approach, with a brief literature overview. We conclude with a description of the procedure, including relevant clinical pearls and common pitfalls.


TEP Totally extraperitoneal Minimally invasive repair Laparoscopic repair 

Supplementary material

Video (MP4 1875482 kb)


  1. 1.
    Kingsnorth A, Leblanc K. Hernias: inguinal and incisional. Lancet. 2003;362(9395):1561–71.CrossRefGoogle Scholar
  2. 2.
    Scott NW, Mccormack K, Graham P, Go PM, Ross SJ, Grant AM. Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev. 2002;(4):CD002197.Google Scholar
  3. 3.
    Jacob BP, Ramshaw B. The SAGES manual of hernia repair. New York: Springer; 2012.Google Scholar
  4. 4.
    Ger R, Monroe K, Duvivier R, Mishrick A. Management of indirect inguinal hernias by laparoscopic closure of the neck of the sac. Am J Surg. 1990;159(4):370–3.CrossRefGoogle Scholar
  5. 5.
    Schultz L, Graber J, Pietrafitta J, Hickok D. Laser laparoscopic herniorrhaphy: a clinical trial preliminary results. J Laparoendosc Surg. 1990;1(1):41–5.CrossRefGoogle Scholar
  6. 6.
    McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess. 2005;9:1–203, iii–iv.Google Scholar
  7. 7.
    Dedemadi G, Sgourakis G, Karaliotas C, Christofides T, Kouraklis G, Karaliotas C. Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study. Surg Endosc. 2006;20(7):1099–104.CrossRefGoogle Scholar
  8. 8.
    Schrenk P, Woisetschläger R, Rieger R, Wayand W. Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair. Br J Surg. 1996;83(11):1563–6.CrossRefGoogle Scholar
  9. 9.
    Wake BL, Mccormack K, Fraser C, Vale L, Perez J, Grant AM. Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2005;(1):CD004703.Google Scholar
  10. 10.
    Krishna A, Misra MC, Bansal VK, et al. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc. 2012;26(3):639–49.CrossRefGoogle Scholar
  11. 11.
    Gong K, Zhang N, Lu Y, et al. Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc. 2011;25(1):234–9.CrossRefGoogle Scholar
  12. 12.
    Bringman S, Blomqvist P. Intestinal obstruction after inguinal and femoral hernia repair: a study of 33,275 operations during 1992-2000 in Sweden. Hernia. 2005;9(2):178–83.CrossRefGoogle Scholar
  13. 13.
    Jones DB. Master techniques in surgery: hernia. Philadelphia, PA/London: Lippincott Williams & Wilkins; 2012.Google Scholar
  14. 14.
    Ryan EA. Recurrent hernias: an analysis of 369 consecutive cases of recurrent inguinal and femoral hernias. Surg Gynecol Obstet. 1953;96:343–54.PubMedGoogle Scholar
  15. 15.
    Lomanto D, Katara AN. Managing intra-operative complications during totally extraperitoneal repair of inguinal hernia. J Minim Access Surg. 2006;2(3):165–70.CrossRefGoogle Scholar
  16. 16.
    Mangram A, Oguntodu OF, Rodriguez F, et al. Preperitoneal surgery using a self-adhesive mesh for inguinal hernia repair. JSLS. 2014;18(4):e2014.00229.CrossRefGoogle Scholar
  17. 17.
    Berney CR, Yeo AE. Mesh fixation with fibrin sealant during endoscopic totally extraperitoneal inguinal hernia approach: a review of 640 repairs. Hernia. 2013;17(6):709–17.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • David J. Berler
    • 1
  • Brian P. Jacob
    • 2
  1. 1.Resident in General SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Icahn School of Medicine at Mount SinaiNew YorkUSA

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