The totally extraperitoneal laparoscopic hernia repair Preliminary results

Abstract

The totally extraperitoneal laparoscopic approach for repairing inguinal hernia should have a promising future, because the same principles as the classical tension-free repair are followed. Preliminary results are promising. Further studies, even randomized prospective trials and fair reports of complications, will determine the future of laparoscopic hernia surgery.

Endoscopic total extraperitoneal repair of primary and recurrent inguinal hernias

“…Thanks to promising early reports indicating rapid recuperation and a low recurrence rate after short follow-up, laparoscopic repair is gaining in popularity for the treatment of inguinal hernias [4,5,16,18,26]. The use of prosthetic mesh to create a tension-free repair and the endoscopic technique itself are major factors in these excellent results.…”

“…The complications of the intraperitoneal onlay mesh technique (IPOM) and the transabdominal preperitoneal procedure (TAPP) appeared to be the consequence of (a) adhesion of the bowel to the intraabdominally positioned mesh, (b) exposure of parts of the mesh after inadequate closure of the peritoneum, or (c) injury of the intraabdominal organs [5,19,25]. Because these risks are lower with the total extraperitoneal procedure (TEP), it is therefore our technique of choice in most situations [3,5,9,19,22,26]. In our study of TEP repair for unilateral primary hernias and recurrent hernias after conventional repair, the occurrence of perioperative and postoperative complications was low and comparable to other reports on endoscopic hernia repair [4-7, 18, 22, 24].…”

“…Some promising reports on endoscopic hernia repair have been published [4,5,16,18,26]; however follow-up in these studies has been short. When compared to the transabdominal preperitoneal procedure (TAPP), the total extraperitoneal (TEP) procedure seems to have a lower potential for intraperitoneal complications; TEP repair is therefore the procedure of choice in most situations [3,5,9,19,22].…”

Intraabdominal adhesion formation after preperitoneal dissection in the murine model

“…New methods of herniorraphy involving laparoscopy have been developed and have gained popularity among many surgeons [6]. Many advantages to laparoscopic herniorraphy have been shown and include reduced postoperative pain compared with traditional procedures, a low recurrence rate, a low complication rate, and reduced postoperative disability [14]. Laparoscopic techniques that involve entering the peritoneal cavity, however, especially with intra-peritoneal placement of mesh, can be complicated by adhesion formation, which has led to obstruction, volvulus, and intestinal dysfunction [9,10].…”

Laparoscopic repair of inguinal hernias with wide prosthesis using Stoppa's principles: analysis of 920 sites operated in 800 patients

“…To reproduce the procedure of Stoppa two laparoscopic approaches are possible [Arregui 1993, Corbitt 1993, MacKernan 1995, Felix 1995, Fitzgibbons 1994, Vanclooster 1996, Velasco 1996]. These are the total extraperitoneal approach (TEP), and the transabdomino-preperitoneal approach (TAPP).…”