Total Extraperitoneal Repair

The total extraperitoneal (TEP) repair is a minimally invasive surgical technique used to treat inguinal hernias. This approach involves making small incisions in the abdominal wall, through which a laparoscope and surgical instruments are inserted to repair the hernia.

Indications

The TEP repair is typically indicated for:

• Unilateral or bilateral inguinal hernias
• Recurrent inguinal hernias
• Hernias in patients with previous lower abdominal surgery
• Hernias in patients with compromised abdominal wall integrity

Surgical Technique

The TEP repair involves the following steps:

1. A small incision (usually 1-2 cm) is made below the umbilicus, and a laparoscope is inserted to visualize the hernia.
2. Two additional ports are inserted, one on either side of the midline, to allow for the introduction of surgical instruments.
3. The peritoneum is dissected and retracted to expose the hernia defect.
4. A mesh prosthesis is placed over the hernia defect to reinforce the weakened area.
5. The mesh is secured in place using sutures, staples, or a fixation device.
6. The peritoneum is closed over the mesh, and the ports are removed.

Advantages

The TEP repair offers several advantages, including:

• Less postoperative pain and discomfort
• Faster recovery time compared to open hernia repair
• Lower risk of wound complications and infection
• Improved cosmesis due to smaller incisions
• Reduced risk of adhesions and bowel obstruction

Complications

Possible complications of the TEP repair include:

• Bleeding or hematoma
• Infection or abscess formation
• Nerve injury or numbness
• Mesh migration or erosion
• Recurrence of the hernia
• Urinary retention or bladder injury

Postoperative Care

After a TEP repair, patients typically:

• Are discharged from the hospital on the same day or the next day
• Experience mild to moderate pain, which is managed with analgesics
• Are advised to avoid heavy lifting, bending, or strenuous activities for several weeks
• Can return to normal activities and work within 1-2 weeks

Outcomes

The TEP repair has been shown to have excellent outcomes, with:

• High success rates (95-98%) in terms of hernia recurrence
• Low complication rates (1-5%)
• Improved patient satisfaction and quality of life