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01-12-2012 | How-I-Do-It article

Totally extraperitoneal repair of inguinal hernia: techniques and pitfalls of a challenging procedure

Authors: Soni Putnis, Christophe R. Berney

Published in: Langenbeck's Archives of Surgery | Issue 8/2012

Abstract

Inguinal hernia repair is the most common procedure performed worldwide in general surgery. Since the turn of the 21st century, the minimally invasive approach and in particular totally extraperitoneal (TEP) repair has gained in popularity. The concept of the TEP approach combines the advantages of anterior tension-free mesh repair (Lichtenstein repair) and the open preperitoneal approach championed by Stoppa. TEP repair uses a prosthetic mesh significantly bigger than in open herniorrhaphy, offering a complete overlap of the myopectineal orifice. TEP repair is a challenging technique with unfamiliar anatomy, a limited operative field, and long learning curve. This article provides an experienced opinion on the practical aspects of the TEP approach. Some of these steps have already been discussed in the surgical literature, while others are the fruit of a personal expertise grasped over the years with more than 1,000 TEP repairs performed.

Rutkow IM, Robbins AW (1993) Demographic, classificatory and socioeconomic aspects of hernia repair in the Unites States. Surg Clin N Am 73:413–426PubMed

Simons MP, Aufenacker T, Bay-Neilsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society Guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403PubMedCrossRef

Goo TT, Lawenko M, Cheah WK, Tan C, Lomanto D (2010) Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5 year review. Hernia 14:477–480PubMedCrossRef

Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193PubMedCrossRef

Stoppa RE, Warlaumount CK (1995) The preperitoneal approach and prosthetic repair of groin hernias. In: Nyhus LM, Coldon RE (eds) Hernia, 4th edn. JB Lippincott, Philadelphia, pp 118–210

Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society(IEHS)]. Surg Endosc 25:2773–2843PubMedCrossRef

McCormack K, Scott N, Go PM, Ross S, Grant AM; EU Hernia Trialists Collaboration (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev Art. No.:CD001785

Langeveld HR, van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lange J, Bonjer HJ, Jeekel J (2010) Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL Trial): a randomized controlled trial. Ann Surg 251:819–824PubMedCrossRef

Gong K, Zhang N, Lu Y, Zhu B, Zhang Z, Du D, Zhao X, Jiang H (2011) Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc 25:234–239PubMedCrossRef

10.

Dulucq JL, Wintringer P, Mahajna A (2011) Occult hernias detected by laparoscopic totally extra-peritoneal inguinal hernia repair: a prospective study. Hernia 15:399–402PubMedCrossRef

11.

Edwards CC 2nd, Bailey RW (2000) Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 10:149–153PubMed

12.

Lal P, Kaila RK, Chander J, Ramteke VK (2004) Laparoscopic total extraperitoneal (TEP) inguinal hernia repair: overcoming the learning curve. Surg Endosc 18:642–645PubMedCrossRef

13.

Lau H, Patil NG, Yuen WK, Lee F (2002) Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. Surg Endosc 16:1724–1728PubMedCrossRef

14.

Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons RJ, Dunlop D, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827PubMedCrossRef

15.

Zendejas B, Onkendi EO, Brahmbhatt RD, Greenlee SM, Lohse CM, Farley DR (2011) Long-term outcomes of laparoscopic totally extraperitoneal inguinal hernia repairs performed by supervised surgical trainees. Am J Surg 201:379–383PubMedCrossRef

16.

Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicentre trial with 5-year follow-up. Ann Surg 249:33–38PubMedCrossRef

17.

Carter J, Duh QY (2011) Laparoscopic repair of inguinal hernias. World J Surg 35:1519–1525PubMedCrossRef

18.

McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 9:1–203, iii–ivPubMed

19.

Tanner J, Moncaster K, Woodings D (2007) Preoperative hair removal: a systematic review. J Perioper Pract 17(118–121):124–132

20.

Berney CR (2011) Unusual clinical presentation of a preperitoneal hernia following endoscopic totally extraperitoneal inguinoscrotal hernia repair. Hernia [Epub, ahead of print]

21.

Berney CR (2011) The endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach. Hernia [Epub ahead of print]

22.

Putnis S, Wong A, Berney CR (2011) Synchronous femoral hernias diagnosed during laparoscopic inguinal hernia repair. Surg Endosc 25:3752–3754PubMedCrossRef

23.

Yuan JT, Shu MP, Ya LL, Ke HY, You CZ, Jin HT, Jian XH (2011) A meta-analysis of randomized controlled trial of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal hernia repair. Surg Endosc 25:2849–2858CrossRef

24.

Ka-Wai T, Hung-Hua L, Chiah-Yang C (2010) Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Surg 34:3065–3074CrossRef

25.

Tamme C, Scheidbach H, Hampe C, Schneider C, Kockerling F (2003) Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Results of 5203 hernia repairs. Surg Endosc 17:190–195PubMedCrossRef

26.

Schwab R, Schumacher O, Junge K, Binnebosel M, Klinge U, Becker HP, Schumpelick V (2008) Biomechanical analyses of mesh fixation in TAPP and TEP hernia repair. Surg Endosc 22:731–738PubMedCrossRef

27.

Amid PK (2004) Radiologic images of meshoma: a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg 139:1297–1298PubMedCrossRef

28.

Schwab R, Schumacher O, Junge K, Binnebösel M, Klinge U, Becker HP, Schumpelick V (2008) Biomechanical analyses of mesh fixation in TAPP and TEP hernia repair. Surg Endosc 22:731–738PubMedCrossRef

29.

Shinde PT (2009) Fibrin sealant versus use of tackers for fixation of mesh in laparoscopic inguinal hernia repair. World J Laparosc Surg 2:42–48CrossRef

30.

Wong J, Anvari M (2001) Treatment of inguinodynia after laparoscopic herniorrhaphy: a combined laparoscopic and fluoroscopic approach to the removal of helical tackers. Surg Laparosc Endosc Percutan Tech 11:148–151PubMed

31.

Lowham AS, Filipi CJ, Fitzgibbons RJ, Stoppa R, Wantz GE, Felix EL, Crafton WB (1997) Mechanisms of hernia recurrence after preperitoneal mesh repair. Traditional and laparoscopic. Ann Surg 225:422–431PubMedCrossRef

32.

Khaleal F, Berney CR (2011) The role of fibrin glue in decreasing chronic pain in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair: a single surgeon’s experience. ANZ J Surg 81:154–158PubMedCrossRef

33.

Lovisetto F, Zonta S, Rota E, Mazzilli M, Bardone M, Bottero L, Faillace G, Longoni M (2007) Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg 245:222–231PubMedCrossRef

34.

Topart P, Vandenbroucke F, Lozac’h P (2005) Tisseel versus tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias. Surg Endosc 19:724–727PubMedCrossRef

35.

Kaul A, Hutfless S, Le H, Hamed SA, Tymitz K, Nguyen H, Marohn MR (2012) Staple versus fibrin fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis. Surg Endosc 26:1269–1278PubMedCrossRef

Title: Totally extraperitoneal repair of inguinal hernia: techniques and pitfalls of a challenging procedure
Authors: Soni Putnis
Christophe R. Berney
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 8/2012
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-012-0999-4

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Totally extraperitoneal repair of inguinal hernia: techniques and pitfalls of a challenging procedure

Abstract

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