A Comparative Study of Extended View – Totally Extraperitoneal Repair versus Totally Extraperitoneal Repair for Laparoscopic Inguinal Hernia Surgery
Abstract
Background: Inguinal hernia forms a major volume of surgical work in any department of general surgery. The rapid pace of developments in technology and better understanding of anatomy of anterior abdominal wall was a compelling factor to undertake this study.
Materials and Methods: The study was carried out in a tertiary hospital, Saveetha Medical College and Hospital, in the Department of General Surgery for a period of 18 months. It is a prospective cohort study with 50 subjects included in the study. P < 0.05 was considered significant. The test of significance was calculated using Chi-square test.
Results: Comparing totally extraperitoneal repair (TEP) versus Extended TEP (e-TEP), P = 0.004 for managing accidental pneumoperitoneum was observed, which was significant, favoring e-TEP over TEP. While analyzing the pain score, P < 0.045 was seen, which was considered to be significant for e-TEP .
Conclusions: It was concluded that e-TEP had an advantage over TEP with very less chance or virtually no chance of being converted to open or TAPP. The rate of recovery was better in e-TEP, with significant p value favoring e-TEP over TEP. Hence it has become a norm in our unit, to prefer e-TEP over TEP for all types of inguinal hernias that can be managed laparoscopically.
References
Inguinal Hernia. London: IntechOpen; 2014. p. 1.
2. Skandalakis JE, Gray SW, Skandalakis LJ, Colborn GL,
Pemberton LB. Surgical anatomy of the inguinal area. World
J Surg 1989;13:490-8.
3. Stoppa R, Hee RV. Surgical anatomy of the groin region. Acta Chir Belg 1998;98:124-6.
4. Daes J. The enhanced view-totally extraperitoneal technique
for repair of inguinal hernia. Surg Endosc 2012;26:1187-9.
5. Ramshaw B, Shuler FW, Jones HB, Duncan TD, White J,
Wilson R, et al. Laparoscopic inguinal hernia repair. Surg
Endosc 2001;15:50-4.
6. Frankum CE, Ramshaw BJ, White J, Duncan TD.
Laparoscopic repair of bilateral and recurrent hernias. Am
Surg 1999;65:839-42; discussion 842-3.
7. Ismail M, Garg P. Laparoscopic inguinal total extraperitoneal
hernia repair under spinal anesthesia without mesh fixation
in 1, 220 hernia repairs. Hernia 2009;13:115-9.
8. Taylor C, Layani L, Liew V, Ghusn M, Crampton N, White S.
Laparoscopic inguinal hernia repair without mesh fixation,
early results of a large randomised clinical trial. Surg Endosc
2008;22:757-62.
9. Lau H, Lee F. Seroma following endoscopic extraperitoneal
inguinal hernioplasty. Surg Endosc 2003;17:1773-7.
10. Li J, Ji Z, Shao X. Prevention of seroma formation after
laparoscopic inguinoscrotal indirect hernia repair by a new
surgical technique: A preliminary report. Int J Abdom Wall
Hernia Surg 2018;1:55-9.
11. Baig SJ, Priya P. Extended totally extraperitoneal repair
(eTEP) for ventral hernias: Short-term results from a
single centre. J Minim Access Surg 2019;15:198-203.
13. Taylor CJ, Wilson T. Long‐term results of laparoscopic
totally extraperitoneal inguinal herniorrhaphy. ANZ J Surg
2005;75:637-9.
12. Brans E, Reininga IH, Balink H, Munzebrock AV, Bessem B,
de Graaf JS. Early recovery after endoscopic totally
extraperitoneal (TEP) hernia repair in athletes with
inguinal disruption: A prospective cohort study. PLoS One
2019;14:e0226011.
13. Taylor CJ, Wilson T. Long‐term results of laparoscopic
totally extraperitoneal inguinal herniorrhaphy. ANZ J Surg
2005;75:637-9.
14. Lau H, Patil NG, Yuen WK, Lee F. Prevalence and severity of
chronic groin pain after endoscopic totally extraperitoneal
inguinal hernioplasty. Surg Endosc 2003;17:1620-3.
15. Deshpande RK, Talwar S. A novel laparoscopic approach:
(e-TEP) technique in ventral abdominal hernia-our
experience. Int J Surg 2019;3:22-5.
16. Penchev D, Kotashev G, Mutafchiyski V. Endoscopic enhancedview
totally extraperitoneal retromuscular approach for
ventral hernia repair. Surg Endosc 2019;33:3749-56.
17. Belyansky I, Daes J, Radu VG, Balasubramanian R,
Zahiri HR, Weltz AS, et al. A novel approach using the
enhanced-view totally extraperitoneal (eTEP) technique
for laparoscopic retromuscular hernia repair. Surg Endosc
2018;32:1525-32.