The totally extraperitoneal approach (TEP) to inguinal hernia repair

Abstract

INTRODUCTION Laparoscopic hernia surgery has been the subject of over 40 randomized trials. Many metaanalyses have drawn together their results, the most recent and possibly the least biased from NICE 2004 con rms the proven bene ts of accelerated recovery, less early and persistent post-operative pain and reduced risk of wound bleeding, seroma and infection after laparoscopic hernia repair.1 Recurrence rates are the same as open mesh repair. Open repair has no proven bene t over laparoscopic repair except that it is technically easier to perform. Major blood vessel, bowel and bladder injury are extremely rare and mostly associated with the trans-abdominal pre-peritoneal (TAPP) technique. NICE recommends that patients should be made aware of the risks and bene ts of open and laparoscopic mesh repair. It is dif cult to know why a patient might opt for open surgery when made fully aware of the facts. We believe that laparoscopic totally extra-peritoneal (TEP) repair, carried out by appropriately trained surgeons, is superior to open hernia repair. NICE also states that laparoscopic TEP repair should only be performed by trained surgeons but does not de ne what constitutes a “trained” operator. This practical guide to the operation of laparoscopic TEP repair is based on the combined 10-year experience of over 1000 operations performed by two surgeons. Laparoscopic TEP repair can be performed without expensive technical aids such as balloon dissectors, specialised ports or staple guns for mesh xation. In our routine hospital practice, it is performed in slightly less time than open repair in equivalent patients. SURGICAL PROCEDURE