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Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with previous lower abdominal surgery

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Abstract

Background

We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20 years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach.

Methods

From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed.

Results

Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair.

Conclusion

The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.

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Authors and Affiliations

  1. Department of Surgery, Yuki Hospital, 9629-1, Yuki, Ibaraki, Japan

    Toru Zuiki, Jun Ohki & Masanori Ochi

  2. Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan

    Alan Kawarai Lefor

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  1. Toru Zuiki
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  2. Jun Ohki
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Correspondence to Toru Zuiki.

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Drs. Toru Zuiki, Jun Ohki, Masanori Ochi, and Alan Kawarai Lefor have no conflicts of interest or financial ties to disclose.

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Zuiki, T., Ohki, J., Ochi, M. et al. Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with previous lower abdominal surgery. Surg Endosc 32, 4757–4762 (2018). https://doi.org/10.1007/s00464-018-6223-z

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