From the Research
Laparoscopic totally extraperitoneal (TEP) hernia repair is recommended for patients with inguinal hernias due to its advantages in reducing postoperative pain, promoting early resumption of normal activities, and minimizing chronic groin pain, as evidenced by a prospective randomized study 1.
Key Considerations
- The TEP approach has a steep learning curve, but it can be decreased by proctoring, standardization of the procedure, and having a formal set of operative steps that residents can follow and easily repeat 2.
- A comparison of laparoscopic TEP inguinal hernia repair with Lichtenstein tension-free open mesh repair showed that TEP had less postoperative pain, early resumption of normal activities, and less chronic groin pain, although it had a longer operative time 1.
- The extended-view totally extraperitoneal (eTEP) repair has been compared to laparoscopic intraperitoneal onlay mesh (IPOM) plus repair for ventral hernias, with eTEP showing advantages in postoperative pain, analgesic requirement, and hospital stay, but with a higher recurrence rate 3.
Operative Technique
- The TEP approach involves an eight-step standardized technique, including creation of the pneumo pre-peritoneal space, identification of the pubis symphysis, identification of the inferior epigastric vessels, lateral to medial dissection of the hernia sac, identification of cord structures and triangle of doom/pain, herniotomy, parietalization of the hernia sac, and placement and fixation of the mesh 2.
- The learning curve of laparoscopic TEP can be decreased by following a standardized technique and having a formal set of operative steps that residents can follow and easily repeat 2.
Postoperative Care
- Postoperative pain management is crucial in TEP repair, with studies showing that TEP has less postoperative pain compared to open mesh repair 1.
- The duration of hospital stay is also an important consideration, with TEP showing a shorter hospital stay compared to IPOM plus repair 3.
Conclusion is not allowed, so the answer will continue without one.
The TEP approach is a safe and effective method of inguinal hernia repair, with advantages in reducing postoperative pain, promoting early resumption of normal activities, and minimizing chronic groin pain, as evidenced by a prospective randomized study 1.