The enhanced view-totally extraperitoneal technique for repair of inguinal hernia

The totally extraperitoneal (TEP) approach for repair of inguinal hernia is the preferred technique since it does not penetrate the peritoneal cavity, thus avoiding potential intraperitoneal complications. The TEP technique allows for regional or even local plus sedative anesthesia, and it gives us an incomparable view of the inguinal region and hernias exactly where they originate. Part of the difficulty with the TEP technique is the limited space it provides for dissection.

We describe a modification of the classical TEP approach which overcomes this limitation: the e-TEP technique. Since October 2010 we have performed 36 e-TEP procedures. Many of these were in difficult cases such as inguinoscrotal and incarcerated hernias and patients with previous radical prostatectomy. We present an initial evaluation of this group of patients.

Results in terms of pain and time off work were the same as with the classical technique. The average operating time was 38 min. This is longer than usual, probably due to the complexity of the cases performed and the time spent in documenting the technique for educational purposes. The peritoneum was often accidentally opened and air leaked into the peritoneal cavity without interfering with the completion of the surgery. We had two small seromas and one case of skin sloughing at the umbilical wound in a case of umbilical and bilateral inguinal hernias. We have had no recurrences, but follow-up has been short.

Our initial experience with the e-TEP technique has been satisfactory. We have had no conversions in spite of the difficult cases selected. There were no major complications, and functional results were excellent. We believe this modification has a place in the armamentarium for hernia repair.