Total extraperitoneal (TEP) hernia repair

Published on 09/04/2015 by admin

Filed under Surgery

Last modified 09/04/2015

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CHAPTER 15 Total extraperitoneal (TEP) hernia repair

Step 2. Preoperative considerations

Patient selection

Relative to standard open inguinal herniorrhaphy, the laparoscopic approach provides superb laparoscopic visualization of the inguinal anatomy with magnified views, with the added benefit of being able to evaluate and repair the contralateral side without the need for additional incisions. Relative to open hernia repair, the laparoscopic approach is associated with improved cosmesis, reduced postoperative pain, faster recovery and return to work, and similar complication and recurrence rates. In the setting of a recurrent inguinal hernia following previous open repair, a laparoscopic repair is the preferred approach. Not only does it avoid dissection through old scar, but it is associated with reduced postoperative and recovery time and similar or improved recurrence rates compared with reoperative open herniorrhaphy.

Laparoscopic repair can be performed either transabdominally (TAPP) or totally extraperitoneally (TEP); the choice largely depends on the surgeon’s experience and preference.

Relative to TAPP, TEP, which is performed without violating the peritoneal space, may reduce the incidence of postoperative adhesions.

Absolute contraindications to laparoscopic inguinal hernia repair include any medical condition that precludes general anesthesia, such as severe cardiac or pulmonary disease. Other contraindications include incarcerated and potentially strangulated hernia. Relative contraindications include previous prostatic surgery, which will distort anatomic planes. In addition, TEP repair may complicate future prostatic surgery, which should be a consideration for older male patients.