From the Guidelines
Thromboembolism prophylaxis (TEP) is not directly addressed in the provided evidence, however, in the context of hernia repair, prophylaxis against thromboembolism is crucial for patients at risk. When considering TEP in patients undergoing hernia repair, it's essential to assess the patient's risk factors for developing blood clots, such as immobilization, surgery, or history of deep vein thrombosis 1. In general, for patients at risk, enoxaparin 40mg subcutaneously once daily or fondaparinux 2.5mg subcutaneously once daily can be considered for medical patients, while for surgical patients, enoxaparin 40mg subcutaneously once daily starting 12 hours before surgery or 6-12 hours after surgery can be used 1. Some key points to consider in TEP include:
- Continuing prophylaxis until the patient is fully mobile or discharged
- Considering extended prophylaxis after high-risk orthopedic surgery for 28-35 days
- Using mechanical methods like intermittent pneumatic compression devices in patients with contraindications to anticoagulants
- Adjusting dosages for patients with renal impairment, such as reducing enoxaparin to 30mg daily or considering unfractionated heparin 5000 units subcutaneously every 8-12 hours 1. The choice of TEP should be individualized based on the patient's risk factors, surgical procedure, and medical history, with the goal of preventing thromboembolic events while minimizing the risk of bleeding complications. It's also important to note that the provided evidence focuses on hernia repair guidelines, and while it does not directly address TEP, it emphasizes the importance of considering the patient's overall health and risk factors when making medical decisions 1.
From the Research
TEP Procedure Overview
- The Totally Extraperitoneal (TEP) approach is a surgical technique used for inguinal hernia repair and ventral hernias 2, 3, 4, 5, 6
- This method involves placing a mesh in the preperitoneal space to reinforce the weakened area in the abdominal wall
Comparison with Other Surgical Techniques
- A study compared TEP with Lichtenstein tension-free open mesh inguinal hernia repair, finding that TEP resulted in less postoperative pain, early resumption of normal activities, and less chronic groin pain 2
- Another study compared Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) repair with Intraperitoneal Onlay Mesh (IPOM Plus) repair for primary ventral hernias, finding that eTEP-RS had advantages such as less postoperative pain and fewer complications 3
- A retrospective study compared Laparoscopic Total Extraperitoneal Repair (LTEPR) with Open Prolene Hernia System Repair (OPHSR) for inguinal hernia repair, finding similar outcomes but with LTEPR having shorter operative time and better scar satisfaction 5
Learning Curve and Outcomes
- A study found that the TEP approach has a favorable learning curve for trainees, with no significant difference in operative time among different levels of surgical residents 4
- The same study reported a low recurrence rate of less than 1% after a learning curve of 40 patients for the staff surgeon 4
- Another study reported short-term results from a single center using the Extended Totally Extraperitoneal (eTEP) repair for ventral hernias, finding low rates of surgical site occurrences and recurrence 6