Laparoscopic TEP Research Articles

Totally Extra Peritoneal Management of Inguinal Hernia Repair: Our Experience in a Public Sector Hospital

Objective: The study objective is to analyze the clinical effectiveness and efficiency of laparoscopic TEP in our set up and to determine its surgical outcomes regarding incidence of early and late post-operative complications. Materials and Methods: A retrospective descriptive study was conducted at Surgical Unit II, Benazir Bhutto Hospital, Rawalpindi Medical University for 5 years and 6 months from January 2018 to June 2023. After approval from the ethical board, data was collected as a qualitative research study through focus group interviews. Adult patients aged between 20 to 70 years, selected by retrospective consecutive sampling who were presented in surgical OPD with unilateral, bilateral, or recurrent inguinal hernia, underwent laparoscopic TEP hernia repair. Patients were reviewed on 1st post-operative day, during 1st week, and at 6 months to 1 year post-surgery. Data was entered into a standard SPSS sheet version 26. Results: The primary outcomes were evaluated based on early postoperative complications including wound infection, seromas or hematoma, urinary retention and abscess formation or mesh infection, and late complications including recurrence and chronic pain. Clear advantages were observed for the laparoscopic TEP technique regarding early return to normal daily activities due to reduced postoperative complications. Conclusions: The newer advanced concepts in hernia surgeries have proven to have good control over early complications, and postoperative pain, with minimal recurrence. Surgeons should acquire adequate experience and anatomical knowledge before performing this advanced inguinal repair surgery.

Comparison of operative outcome of open versus laparoscopic inguinal hernia in rural tertiary care hospital in Haryana: A randomized controlled study

Background: Hernia surgery is one of the commonly done procedures in General surgery. A hernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Aims and Objectives: Comparison of morbidity in terms of total analgesic usage, mean length of hospital stay, comparison among open and TEP repair of hernias in primary inguinal hernias among males. Material and Methods: This study was done on 80 patients with clinical diagnosis of primary inguinal hernia over a period of one year to compare the result of two surgeries, open lichenstein repair (n=40) and TEP repair (n=40). Results: Postoperative pain using VAS was found to be lower in patients having laparoscopic TEP hernia repair when compared to open lichenstein tension free repair (p <0.01). Operating time was observed to be more with TEP group with mean of 59 ± 17.02 minutes compared with open group which had mean of 44.92±12 minutes. Mean number of analgesic in open cases was 6.65 ± 1.81 whereas in case of TEP group it was 4.35±1.47 over a period of one month. Conclusion: Lichtenstein tension free mesh hernioplasty still remains the gold standard operation done for inguinal hernia. TEP repair has proven to be superior in terms of perioperative hemorrhage and post-operative analgesia requirement. Study concluded that laparoscopic TEP repair of inguinal repair have a considerable clinical advantage over open hernia repair in terms of postoperative pain and analgesia requirement, hospital stay and postoperative complications.

Can e-TEP be a Better Option than TEP for Inguinal Hernia Repair?

Background: An organ or fatty tissue, like the colon, might abnormally emerge through the wall of the cavity in which it normally resides, for making a hernia. Among different hernias inguinal hernia repair is the most frequently done procedures by surgeons in Bangladesh and worldwide. Now-a-days Laparoscopic repair is performed in this country and accepted by the people. Laparoscopic TEP and e-TEP are excellent procedure for repair of inguinal hernia. In this Centre, we performed both procedures. In Technical aspects e-TEP is better approachable than TEP. Objective: In this article we present how to overcome the difficulties of TEP technique by doing the enhanced view totally extra peritoneal technique for repair of inguinal hernia. Methods: It is a non-randomized comparative study. The study consists of patients with laparoscopic hernioplasty for the period of one year (From July 2018 to July 2019). Total 20 cases were included in the study (10 cases of Laparoscopic e-TEP and 10 cases of Laparoscopic TEP). Data were collected by follow up visit, questionnaire and by phone call. Results: The study consists of 20 patients among whom 10 were placed in group A (e-TEP group) and 10 cases were placed in group B (TEP group). Mean operating time in group A was 108.5 min while in group B was 114 min. Pain scoring in group A was 75% and giving score 1-2 (mild pain). All are male. Mean age for e-TEP was 26.5 years and for TEP was 35.6 years. Conclusion: Laparoscopic e-TEP provides wide area than TEP for repair of inguinal hernia. It is a surgeon friendly procedure for repairing hernia. It is easier to learn e-TEP than TEP. JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 21-23

Quadratus lumborum block in laparoscopic inguinal hernia repair: A single center study.

Objective: To evaluate the efficacy of QL block in patients undergoing laparoscopic TEP inguinal hernia repair. Study Design: Randomized Clinical Trial. Setting: Kalsoom International Hospital, Islamabad. Period: Dec 2022 to June 2023. Methods: In this, all patients between the ages of 18 and 70 who were scheduled for laparoscopic TEP inguinal hernia repair to repair a one-sided inguinal hernia and did not have any complications related to the hernia. In one group, the patients received general anesthesia and in the other group, the patients were given sedation along with a technique called QL block. Age, gender, pain score on VAS at 1 hours, 6 hour and 12 hours after procedure was noted. Comparison of pain according to the VAS by type of anesthesia was done between the two groups and independent sample t-test was applied to see the statistical significant. Results: The patients' mean age was 43 + 9.09 years. Around 70% of the patients were males, while 30% were females, indicating a male predominance. The study's outcome was the mean pain score after 1 hour, 6 hours, and 12 hours. The two techniques of anesthesia utilized in the two groups were compared in terms of pain. The mean VAS at 1 hour after the initiation of anesthesia was not significantly different between the two groups, but it was statistically significant at 6 and 12 hours (p value of 0.001). Conclusion: QL block is a safe and effective alternative for patients undergoing TEP inguinal repair because to the observed reduction in early postoperative pain, shorter hospitalization, and cheaper anesthetic and hospital costs. Although our research showed that pain was significantly reduced for up to 12 hours after the operation, more information is needed before we can confidently endorse it for widespread use.

Laparoscopic Totally Extra Peritoneal Inguinal Hernia Repair with Endoscope Preperitoneal Dissection and No Mesh Fixation - How I Do It

Background: Laparoscopic or robotic TEP hernia repair represents a minimally invasive surgical technique used in treatment of inguinal or femoral hernia in male or female patients.

OC-026 PERFORMING A SLIT ON THE MESH TO ENCIRCLE THE CORD STRUCTURES DURING LAPAROSCOPIC INGUINAL HERNIA REPAIR - A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Aim There are several modifications in the technique for the placement of mesh during laparoscopic inguinal hernia repair. The present study aimed to provide stronger evidence in establishing whether the slit mesh technique is superior to the non-slit technique (the most common practice). The primary outcome was recurrence and secondary outcomes were postoperative groin pain, bleeding, seroma formation and duration of surgery. Material & Methods Eligible studies had to compare the two methods of mesh placement slit Vs non slit in laparoscopic TEP or TAPP inguinal hernia repair. Databases searched were Embase, Medline, Cochrane collaboration, NICE guidelines search. The meta-analysis was conducted using Review Manager software 5:4. The outcomes were expressed in odd ratios with their 95% confidence intervals. Where significant heterogeneity existed (I2>75%) a random effects model was used otherwise a fixed effects model was used. Results Five studies included, all were single centre studies, 4 retrospective and one prospective observational studies. 1076 patients included, 633 in the slit group and 434 in the non-slit group. The male to female ration was 9:1. There were 10 (1.5%) recurrences in the slit group compared to 12 (2.5%) in the non-slit group 0.62, 95% CI (0.27–1.41). There was no difference in the incidence of post-operative bleeding (1.21, 95%CI 0.4–3.66), seroma formation (1.5, 95% CI 0.81–2.76), or post-operative neuralgia (0.98, 95%CI 0.11–8.92). Conclusion There is no advantage in performing a slit on the mesh to encircle the cord structures during laparoscopic inguinal hernia repair.

A FEATURE OF LAPAROSCOPIC TREATMENT OF IRREDUCIBLE AND LARGE INGUINAL HERNIAS

Summary. Introduction. The inguinal hernia is one of the most common surgical problems around the world. Patients with large inguinal and inguinal hernias are a certain group. At present, there are no final convincing evidence of the advantage of laparoscopic hernia repair of complex forms of inguinal hernias, indications and contraindications to various methods of this operation, the technology of performing surgical interventions for various types of complex inguinal hernias has not been completed.
 Aim. Perform perioperative complications in surgical treatment of unrecognizable and large inguinal hernias with laparoscopic modified TAPP method, classic Laparoscopic TEP laparoscopic technique and inguinal canal plastic according to Lichtenstein.
 Materials and methods. Surgical treatment of 42 patients with unrecognizable and large inguinal hernias was performed. All of them were performed incapacitated plastic with the use of a prone grid. In 12 patients, the Lichtenstein (Lichtenstein group) was performed, 18 patients with a modified technique (TAPP group) and 12 — TEP (TEP group). Modification was a high resection of the hernia sac in patients with inguinal-callous hernia, and the techniques of digestion of the peritoneum with a fixed gut in cases where the intestine is tightly fictoned in a large length to the peritoneum in the area of the hernia sac.
 Results of the research. Application in the performance of transabdominal preperitoneal hernia repair of the technique of high resection of the hernia sac in patients with inguinal-potassium hernia, and methods Surgery, reduce the frequency of hematoma and inflammatory processes in the TAPP surgery area is likely (p < 0.05), and reduce the number of conversions in the TAPP group.
 Conclusions. Diagnostic laparoscopy is a necessary highly informative stage of diagnosis and determination of surgical tactics for complex types of inguinal hernias. Laparoscopic hernia repair of complex forms of inguinal hernias is a method of choice, which provides low trauma, asepticity, good conditions for wound healing. Modified technique of transabdominal preperitoneal hernia repair of complex inguinal hernias, which reduced the trauma of the operation and thus reduce intra and postoperative complications that are manifested by the formation of hematoma and inflammatory processes in the surgery.

A technique for laparoscopic extraperitoneal colostomy with an intact posterior sheath of rectus

Regardless of the advances in surgical techniques, parastomal hernia is still an inevitable complication for many patients with low rectal cancer undergoing abdominal perineal resection (APR). Extraperitoneal colostomy (EPC) seems to be a effective method to reduce the risk of parastomal hernia. We propose a new approach to simplify and standardize laparoscopic EPC to make this operation easy to perform. We used the technique of laparoscopic TEP groin hernia repair to produce an extraperitoneal tunnel, which can not only facilitate precise visualization of the extraperitoneal tunnel but also utilize the intact posterior rectus abdominis sheath as biologic materials to maintain soft-tissue augmentation, with a satisfactory result. With laparoscopy, we can create adequate space without insufficient dissection of the extraperitoneal tunnel while avoiding damage to the retrorectus sheath. At the time of writing, we had performed this method in four patients, without any complications. This technique is effective at preventing parastomal hernia without extra costs.

Laparoscopic TEP Inguinal Hernia Repair for Recurrent Inguinal Hernia in an Adult with History of Herniotomy Done for Congenital Inguinal Hernia in Childhood - A Rare Case Report

Laparoscopic TEP Inguinal Hernia Repair for Recurrent Inguinal Hernia in an Adult with History of Herniotomy Done for Congenital Inguinal Hernia in Childhood - A Rare Case Report

Preperitoneal Prosthetic Repair (Open Tep) for Inguinal Hernias

Background: Inguinal hernia is repaired by placing a polypropylene mesh in the preperitoneal space. The entire procedure is perfomed through a small 3-4 cm incision made in the midline above the pubic symphysis. Pre peritoneal space created by simple digital dissection and retraction. Clear visualisation of the operative site is maintained throughout the procedure with proper dissection. Materials and Methods: One hundred Inguinal Hernia patients including direct, indirect and recurrent inguinal hernias operated under spinal/ epidural anaesthesia by placing polypropylene mesh in the preperitoneal space which is created by digital dissection by giving small incision (3-4 cm) in the lower midline above the pubic symphysis. Results: We found open TEP is beneficial in terms of less operative time. Open TEP also has the advantage of direct visualisation of anatomy, decreasing the learning curve for laparoscopic TEP, avoiding damage to the nerves and less incidence of seroma and hematoma formation and lesser incidence of recurrence. Conclusion: It is an efficient inguinal hernia repair method having all the advantages of Stoppas GPRVS and Laparoscopic TEP with good cosmosis, less cost and better patient compliance.

Comparison of post-operative pain after laparoscopic total extraperitoneal mesh repair of indirect inguinal hernia with tacker

Objectives: To compare the post-operative pain after laparoscopic total extraperitoneal mesh repair of indirect inguinal hernia with tacker and without tacker fixation. Materials & Methods: This comparative study was done at Surgical Department of Bahawal Victoria Hospital, Bahawalpur from May 2020 to November 2020 over the period of 6 months. Total 182 patients with indirect inguinal hernia, having age range from 20 to 60 either male or female were selected. In group A patients, laparoscopic TEP mesh repair of inguinal hernia without tacker fixation was done while in group B patients, laparoscopic TEP mesh repair of inguinal hernia with tacker fixation was done. Patients were assessed for post-operative pain and outcome (satisfactory/unsatisfactory) at 1 month follow up. Results: Average of patients was 41.33 ± 12.37 years and 40.83 ± 12.04 years in group A and group B. Out of 182 patients, 170 (93.41%) were males and 12 (6.59%) were females. Mean post-operative pain in Group A was 1.46 ± 1.50 while in Group B was 1.77 ± 2.08 (p-value=0.2505). Satisfactory outcome was noted in 84 (92.31%) patients and 67 (73.63%) patients of group A and B and the difference was significant (P = 0.001). Conclusion: Results of this study showed that there is a significant difference of satisfactory outcome (less post-operative pain) between the non-fixation and fixation group. Difference of satisfactory outcome was also significant between male patients, diabetics and obese patients of both groups. Keywords: Inguinal hernia, laparoscopic, mesh, tacker fixation

Modified Laparoscopic Sugarbaker Repair of Parastomal Hernia With a Totally Extraperitoneal Technique.

Purpose: Many patients develop a parastomal hernia within the first 2 years of stoma formation, and even surgical repair is associated with high recurrence rates. An intraperitoneal approach is typically used for the laparoscopic repair of parastomal hernia; it is unknown whether a totally extraperitoneal technique (TEP) is feasible. Here we describe a laparoscopic TEP approach using a modified Sugarbaker method for the repair of parastomal hernia.Methods: Seven patients underwent parastomal hernia repair. The retrograde puncture technique was used to create the extrapneumoperitoneum, and the peritoneum was separated with a laparoscopic TEP approach; the mesh was placed using a modified Sugarbaker technique.Results: All patients had an oncologic etiology for stoma creation. The mean (±SD) size of the hernia defect was 3.1 ± 2.7 cm and the mesh size was 303.4 ± 96.8 cm2. The mean operative time was 195.5 ± 20.7 min and average length of hospital stay after surgery was 4.8 ± 2.1 days. One patient had intraoperative subcutaneous emphysema. The average follow-up time was 8.5 ± 2.7 months; mild pain occurred in 2 patients, 3 experienced seroma formation (with no special treatment required), and 1 had early intestinal obstruction (which was treated with conservative care). There was no hernia recurrence, wound complications, or infections of the surgical site or mesh during follow-up.Conclusion: A laparoscopic TEP technique is technically challenging but feasible. Modified laparoscopic Sugarbaker repair of a parastomal hernia with the TEP technique is safe and effective, although the recurrence rate and late complications require confirmation in more cases with long-term follow-up.

Comparative study of inguinal hernia repair by laparoscopic TEP technique and open inguinal hernia repair

Comparative study of inguinal hernia repair by laparoscopic TEP technique and open inguinal hernia repair

Safety and feasibility of single-incision laparoscopic totally extraperitoneal inguinal hernia repair: a retrospective comparative analysis of 163 patients

To analyze the benefit and feasibility of single-incisional laparoscopic totally extraperitoneal (SIL TEP) repair compared with those of conventional laparoscopic TEP (CL TEP). The procedure of laparoscopic herniorrhaphy includes medial, lateral, and sac dissection with mesh positioning. The actual procedure performed during SIL TEP is the same as those of CL TEP, except for the number of incisions. We performed SIL TEP in 23 patients with an inguinal hernia. The operative and short-term outcomes, including postoperative complications and recurrence, were analyzed and compared with 140 cases of CL TEP. Age, gender, BMI, comorbidity, ASA score, and types of hernia were similar in both groups. Also, operation time, open or transabdominal preperitoneal conversion rate, length of hospital stay, postoperative complication rate, and recurrence were not significantly different between the two groups. SIL TEP is as feasible and safe a procedure as laparoscopic herniorrhaphy. Surgeons familiar with single-incision laparoscopic surgeries like appendectomy or cholecystectomy can begin to perform SIL TEP for hernia repair.

The effect of tack number and balloon trocar use on acute post-operative pain scores of patients who underwent TEP repair of inguinal hernia

Aim: As the novel technology on surgical procedures evolve, the management and amelioration strategies for postoperative pain gains importance for surgeons to improve patients’ life quality and postoperative outcomes. In this study, we aimed to compare the number of tacks placed during surgery and the use of intra-operative balloon trocars during TEP repair of inguinal hernias with respect to post-operative early pain scores.Methods: A total of 83 patients were included in this prospective cohort study, 59 being in the 0-1 tack group and 24 in the 2 tacks group. Balloon trocar was used in 32 patients. All patients underwent laparoscopic TEP inguinal hernia repair. Groups were compared with respect to pain scores on 3rd, 12th and 24th postoperative hours. Results: Pain score was better in no balloon trocar+2 tacks group when compared to balloon trocar+2 tacks and no balloon trocar+0-1 tack group at the 24th postoperative hour (P=0.02 and P=0.007, respectively), and in the balloon trocar+0-1 tack group than that of the no balloon trocar+0-1 tack group (P=0.004). There was no statistically significant difference between these four groups in terms of pain score on the 3rd and 12th hours of surgery (P=0.46 and P=0.24, respectively). Patients in the 0-1 tack group reported less pain on the 24th postoperative hour (3.1 (6.3) vs 14.1 (21.8); P=0.32).Conclusion: Using less number of tacks and avoiding using balloon trocar result in lower pain scores following laparoscopic TEP repair of inguinal hernias.

Intracorporeal Suturing of MESH and Peritoneum during TAPP as Substituting for Tackers

Abstract Background groin hernia repair is considered to be one of the most commonly performed operations by general surgeons however; there is no “gold standard” operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities. Aim of the Work is to compare the outcome results of the laparoscopic total extraperitoneal TEP hernia repair with mesh or the transabdominal preperitoneal repair (TAPP) with mesh to those of open repair with mesh. Patients and Methods this is a prospective study conducted on those who are diagnosed to have inguinal hernia (direct, indirect). 40 cases with direct, indirect, unilateral or bilateral inguinal hernia and will be divided into two groups: Group A 20 cases fixation a mesh with Tackers . Group B 20 cases fixation a mesh with intracorporeal sutures. The study will be Conducted at Ain Shams University hospitals (El-Demerdash) and other authorized hospitals under supervision of thesis supervisors. Results smoking appears to be a risk factor for hernia development since almost 55% of the study group A and 65% of the study group B were smokers, obesity also appears to be a risk factor since BMI was about 30.20± 7.82 among group A and 32.05 ± 5.98 among group B. This is in contrast to age which seems not to be as strongly related. Conclusion we found the rate of postoperative early and late complications comparable in both groups. But in the LAP group we were able to discharge them from the hospital faster than the OPEN group, they also resumed full activity early.

Does the use of monopolar energy as the preferred mode of dissection effectively reduce seroma formation in laparoscopic total extra peritoneal hernioplasty? A prospective double-blinded randomized control trial.

Seroma is a commonly encountered sequela after hernia repair. Tremendous effort has been spent to investigate the effective way to prevent this "complication" including the modification of surgical technique, use of per-peritoneal drainage, etc. There were debates about the use of monopolar diathermy versus blunt dissection in laparoscopic TEP in the prevention of seroma formation. This randomized study aims to compare the effects of using 2 techniques in laparoscopic TEP on pre-peritoneal drain output and seroma formation. From 1.9.2018 to 30.9.2019, all male and female patients presented with the first occurrence, unilateral inguinal hernia anticipated for laparoscopic TEP were enrolled into the study after informed consent. Patients were randomized into "monopolar dissection preferred" (MDP) group and "blunt dissection-preferred" (BDP) group just before commencing of operation after general anesthesia. Surgeons were instructed to use monopolar energy as main dissection method for the whole operation if possible (MDP), whereas blunt dissection is the preferred choice in BDP group, but the use of monopolar energy was allowed if needed. Total energy time was measured by a specially designed homemade device attaching to the monopolar pedals as accurate as to millisecond (ms). Pre-peritoneal drains were inserted for drainage and removed 23h after operation. Drainage output, total operating time, energy time, clinical and ultrasonic seroma sizes at day 1, day 6, 1-month post operations, recurrence are compared between 2 groups. A total of 103 patients where included. There was no significant difference in age, gender, co-morbidities, side of hernia, mean defect size, operating time, fixation adjuncts, or postoperative stay. The drain volume in BDP group is 71.13 ± 31.42mL while it in MDP group is 56.36 ± 21.46mL. The MDP group had significantly fewer drain output at 23h post operation (p = 0.007) and lower seroma incidence on days 6 (p = 0.036). Overall incidence of seroma formation was 12% on postoperative day 1, 11% on postoperative day 7. No statistically differences in postoperative pain score or complications were observed at the first week, 1- and 3-months' post operation. There was no correlation with energy time to the drain output. No recurrence was found in subsequent follow-up. Pre-peritoneal drainage is clinically safe in laparoscopic totally extra-peritoneal hernioplasty and can effectively reduce the size and incidence of seroma. The seroma formation can be further reduced by appropriate use of monopolar energy as preferred dissection approach in lap TEP. Due to limitation in measuring the actual energy time, the result should be further validated by randomized multi-centers trial on its potential benefit in hernia repair by a more accurate measuring device on energy used.

Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia : in Terms of Patient Satisfaction

Background- Inguinal hernia is the most common type of external abdominal hernia. Open Lichtenstein method or laparoscopic method can be employed to repair inguinal hernia. The superiority of laparoscopic mesh hernioplasty over open mesh hernioplasty is debatable. Method- This prospective study was done on 120 patients in the department of surgery, LLRM medical college, Meerut to evaluate the usefulness of laparoscopic mesh hernioplasty (TEP Technique) for inguinal hernia repair versus conventional open mesh hernioplasty (Lichtenstein Technique) in terms of complications, pain and recurrence. Equal number of subjects were put in two groups : open mesh repair group and laparoscopic mesh repair group. Results- The mean age of the patients with inguinal hernia including both groups was 50 yrs. The mean operation time of Laparoscopic TEP mesh hernioplasty was 71.33 minutes while that of Open Lichtenstein repair was 36.33 minutes. Postoperative analgesic requirement was significantly lower in the patients operated by TEP technique as compared with patients treated by Open Lichtenstein’s technique. In TEP group, two patients developed neuralgia, one patient developed fever, 1 patient developed hematoma whereas in the open group there were 3 cases of neuralgia formation and 3 cases of fever. Conclusion- In all, Laparoscopic mesh hernioplasty using TEP technique is a novel technique with its share of advantages and disadvantages. There are potential benefits of laparoscopic inguinal hernia repair for inguinal hernias in terms of post-operative pain, hospital stay and post operative complications. We recommend that a surgeon should use this laparoscopic technique for hernia repair after knowing all the pros and cons of the technique, his expertise for the technique and the infrastructure available.

A Comparative Study Between Totally Extraperitoneal (tep) and Trans Abdominal Pre Peritoneal (tapp) Laparoscopic Inguinal Hernia Repair Techniques

Objective: The study was undertaken to compare the efficacy, safety and patient satisfaction between the two techniques of laparoscopic inguinal hernia repair. Methodology: This was a comparative study carried out at a tertiary care hospital from August 2017 to July 2019. Diagnosis of inguinal hernia was made based on history and clinical examination and ultrasound scan of the abdomen. 50 patients enrolled in the study for laparoscopic hernia repair were equally divided into 2 groups, Group A - TEP group and Group B - TAPP group. Results: The outcomes were compared between both groups. The mean operative time required for TEP was 68 minutes and that for TAPP was 81 minutes. No major complications were noted in either TEP group or TAPP group .Minor complication rate was 28 % for Laparoscopic TEP group and 24 % for Laparoscopic TAPP group. The hospital stay in TEP was (2.36 ± 1.43) & that of TAPP was (2.32± 1.47), so it was statistically not significant. Conclusion: Laparoscopic repair of inguinal hernia has a prolonged learning curve but once mastered it can be done with decreased operative time, early post operative recovery and faster return to work. TEP and TAPP both are methods of choice for Laparoscopic inguinal hernia repair and it is difficult to establish the superiority of one over the other. Choice between TEP and TAPP depends on the preference and proficiency of the individual surgeon.

Comparison of laparoscopic totally extraperitoneal mesh hernioplasty with Lichtenstein tension free mesh hernioplasty

Background: The purpose of the study was to observe the differences between the two methods of inguinal hernia repair in terms of operative time, postoperative pain, need for analgesia, hospital stay and postoperative complications.Methods: This prospective study conducted in the department of Surgery, IGMC Shimla, included 40 patients of inguinal hernia who were randomized to TEP and Lichtenstein tension free mesh hernioplasty groups randomly. After thorough clinical examination, whereas all patients with unilateral incomplete inguinal hernia fit for laparoscopic surgery were included in the present study, those with bilateral inguinal hernia, unwilling for laparoscopic surgery or who had complicated and recurrent inguinal hernia, poor cardiopulmonary reserve or were immunocompromised were excluded from the study.Results: Laparoscopic TEP is significantly lengthier procedure than open Lichtenstein repair especially in the learning phase as the mean operative time of TEP repair was 75.6 minutes and that of open Lichtenstein repair was 54 minutes. Not only postoperative pain recorded by using VAS was significantly less in the in the first 4 postoperative hours there was significantly less consumption of post-operative analgesic in TEP as compared to Lichtenstein group. No major complications in either group but only minor complications were observed in TEP group.Conclusions: TEP can be recommended to those desiring better cosmetic results and early return to work as TEP was found to be associated with less pain in the first 4 hours after surgery.