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Published on: December 23, 2022
A randomized controlled trial comparing laparoscopic extended view totally extraperitoneal (eTEP) repair with totally
Pawanindra Lal1, Atulanand Shirodkar2, Stuti Shandelya2
1Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College (University of Delhi), New Delhi, 110002, India. profplal@gmail.com.
Background:
Totally extraperitoneal (TEP) repair has been commonly practiced for over 30 years to manage inguinal hernias. Extended view totally extraperitoneal repair (eTEP) is a newer procedure reported to provide larger extraperitoneal space particularly in patients with shorter body habitus. Data evaluating laparoscopic eTEP and TEP is limited in literature. This study was conducted to compare these procedures in patients with primary inguinal hernia.
Materials And Methods:
Fifty-one patients were randomized into two groups (eTEP = 26 and TEP = 25). Operative time was used as primary endpoint. Complications, postoperative pain, hospital stay, return to activities of daily living, and return to work were secondary endpoints. All patients were followed up for 12 months for recurrence and complications.
Results:
Mean operative time in eTEP (51.56 ± 5.14 min) was significantly lower than TEP (57.48 ± 5.54 min) (p < 0.000). Operative time in cases with accidental pneumoperitoneum was significantly shorter in 3/26 cases of eTEP as compared to 5/25 cases of TEP (p = 0.045). Mean pain scores in eTEP group were significantly lower in comparison with TEP at 6 and 12 h postoperatively (p = 0.032 and 0.034, respectively). Return to activities of daily living and return to work were significantly earlier in eTEP (p = 0.002 and 0.003, respectively). No recurrence was seen in either group at 12 months.
Conclusion:
Operative time was significantly less in eTEP patients, indicating that wider dissection of extraperitoneal space led to better understanding of anatomy, allowing unhindered dissection even in cases with accidental pneumoperitoneum. Reduced pain in the immediate postoperative period in eTEP group was associated with earlier return to activities of daily living and earlier return to work. In this study, eTEP performed comparably to TEP in all respects, with favorable operative times, reduced postoperative pain, and earlier resumption of work.
Trial Registration Number:
CTRI/2023/03/050681.