Optimizing laparoscopic eTEP inguinal hernia repair: challenges and solutions

The field of hernia repair has been revolutionized since the advent of totally extraperitoneal(TEP) repairs. The concept of eTEP(extended view TEP) repairs have further expanded horizons by overcoming the challenges faced in TEP repairs. Although laparoscopic ETEP hernia repairs offer a myriad of advantages, these procedures pose a steep learning curve and may pose complications which maybe difficult to manage. This observational study aims to highlight the complications faced during laparoscopicETEP inguinal hernia repairs at our centre and provide possible solutions for the same.

This is a high volume single-centre, single team prospective observational data of patients undergoing laparoscopicETEP inguinal hernia repairs from January2020 to October2023. We reviewed a total of 252 such patients and collected demographic details, co-morbidities, intra-operative complications and post-operative recovery of the patients.

We have highlighted the possible complications and recommended trouble-shooting approaches to tackle them. The incidence of intra-operative and early complications like early pneumoperitoneum, injury to brick's artery, injury to inferior epigastric artery, peritoneal rents, urinary retention in our study was 5.15%,1.98%,0.4%,10.32%,1.9% respectively. Late complications like seroma, hematoma, chronic pain showed an incidence of 1.59%,0.4%,1.98% respectively. Our cohort did not have any cases of visceral injury(bowel/bladder) or surgical site infection.

It is essential to identify and address complications faced during laparoscopic eTEP repairs to ensure patient safety, improved outcomes, reduced recurrences and surgical site infections. Implementing the suggested strategies may help improve the surgical outcome and in turn post-operative patient well-being and quality of life in patients undergoing eTEP repairs.