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Totally extraperitoneal endoscopic inguinal hernia repair (TEP)
C Tamme1, H Scheidbach, C Hampe
1Department of Surgery and Center for Minimally Invasive Surgery, Hanover Hospital, Roesebeckstrasse 15 (Siloah), 30449 Hanover, Germany. e.c.tamme@t-online.de
Surgical Endoscopy
|November 29, 2002
Summary
Totally extraperitoneal endoscopic hernia repair (TEP) is a safe and effective procedure. This study shows TEP has a low recurrence rate and minimal complications for inguinal hernia repair.
Area of Science:
- Minimally Invasive Surgery
- Gastrointestinal Surgery
- Surgical Innovation
Background:
- Review of 5,203 totally extraperitoneal (TEP) endoscopic hernia repairs in 3,868 patients from May 1994 to December 2001.
- 34.5% of patients had bilateral hernias, and 13% had recurrent hernias.
- TEP was the preferred method for over 92% of inguinal hernia cases, including complex presentations.
Purpose of the Study:
- To evaluate the safety and efficacy of TEP for inguinal hernia repair.
- To assess complication rates and recurrence rates associated with TEP.
- To determine the suitability of TEP for a wide range of inguinal hernias.
Main Methods:
- TEP performed using a slit-free 10 x 15-cm polypropylene mesh without staple fixation.
- Standardized technique involving reduction of the hernial sac and preperitoneal space dissection.
- Inclusion of incarcerated, strangulated, and inguinoscrotal hernias in the TEP approach.
Main Results:
- Overall recurrence rate of 0.6% (29 cases), with rates decreasing from 1.8% to 0.3% over time.
- Low intraoperative complication rate: 8 bladder injuries, no bowel or iliac vessel injuries.
- Postoperative complications included 1 mesh infection, 14 hemorrhages requiring reoperation (0.4%), and 2 small bowel obstructions (0.05%).
Conclusions:
- TEP offers a low complication rate with the benefits of minimally invasive surgery and mesh reinforcement.
- The procedure facilitates early return to normal activities.
- TEP demonstrates a very low recurrence rate, making it a favorable option for inguinal hernia repair.