500 total extraperitoneal approach laparoscopic herniorrhaphies: a single-institution review

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Transabdominal preperitoneal (TAPP) technique for laparoscopic herniorrhaphy may lead to complications.
• The total extraperitoneal approach (TEPA) avoids entering the abdominal cavity, potentially reducing risks.

Purpose of the Study:

• To evaluate the safety and efficacy of the TEPA for laparoscopic herniorrhaphy.
• To assess the use of regional anesthesia (epidural) with the TEPA.
• To compare TEPA outcomes with TAPP, particularly in patients with prior abdominal surgery.

Main Methods:

• A retrospective review of 503 laparoscopic herniorrhaphies performed using the TEPA between June 1993 and the study's conclusion.
• Analysis of complication and recurrence rates.
• Evaluation of epidural anesthesia use in 108 patients, including conversions to general anesthesia.

Main Results:

• The TEPA demonstrated favorable outcomes compared to TAPP, with lower complication and recurrence rates.
• Two recurrences were reported out of 503 procedures.
• Four major complications occurred (two bowel perforations, two cystotomies), with three in patients with prior lower abdominal surgery.
• Epidural anesthesia was used in 108 patients; four required conversion to general anesthesia, all with prior lower abdominal surgery.

Conclusions:

• The TEPA is a viable and effective technique for laparoscopic herniorrhaphy with acceptable complication and recurrence rates.
• Epidural anesthesia is well-tolerated in patients undergoing TEPA.
• Previous lower abdominal surgery may be a mitigating factor in TEPA selection, warranting further investigation.