Skip to main content
main-content
Erschienen in: Surgical Endoscopy 4/2012

01.04.2012 | Technique

The enhanced view–totally extraperitoneal technique for repair of inguinal hernia

verfasst von: Jorge Daes

Erschienen in: Surgical Endoscopy | Ausgabe 4/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

The totally extraperitoneal (TEP) approach for repair of inguinal hernia is the preferred technique since it does not penetrate the peritoneal cavity, thus avoiding potential intraperitoneal complications. The TEP technique allows for regional or even local plus sedative anesthesia, and it gives us an incomparable view of the inguinal region and hernias exactly where they originate. Part of the difficulty with the TEP technique is the limited space it provides for dissection.

Methods

We describe a modification of the classical TEP approach which overcomes this limitation: the e-TEP technique. Since October 2010 we have performed 36 e-TEP procedures. Many of these were in difficult cases such as inguinoscrotal and incarcerated hernias and patients with previous radical prostatectomy. We present an initial evaluation of this group of patients.

Results

Results in terms of pain and time off work were the same as with the classical technique. The average operating time was 38 min. This is longer than usual, probably due to the complexity of the cases performed and the time spent in documenting the technique for educational purposes. The peritoneum was often accidentally opened and air leaked into the peritoneal cavity without interfering with the completion of the surgery. We had two small seromas and one case of skin sloughing at the umbilical wound in a case of umbilical and bilateral inguinal hernias. We have had no recurrences, but follow-up has been short.

Conclusions

Our initial experience with the e-TEP technique has been satisfactory. We have had no conversions in spite of the difficult cases selected. There were no major complications, and functional results were excellent. We believe this modification has a place in the armamentarium for hernia repair.
Literatur
1.
Zurück zum Zitat McCormack K, Scott NW, Go PM, Ross S, Grant A (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. doi: 10.​1002/​14651858 McCormack K, Scott NW, Go PM, Ross S, Grant A (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. doi: 10.​1002/​14651858
2.
Zurück zum Zitat Chung RS, Rowland DY (1999) Meta-analysis of randomized controlled trials of laparoscopic vs. conventional inguinal hernia repairs. Surg Endosc 13:689–694 PubMedCrossRef Chung RS, Rowland DY (1999) Meta-analysis of randomized controlled trials of laparoscopic vs. conventional inguinal hernia repairs. Surg Endosc 13:689–694 PubMedCrossRef
3.
Zurück zum Zitat Memon MA, Cooper NJ, Memon B, Memon M, Abram K (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90(12):1479–1492 PubMedCrossRef Memon MA, Cooper NJ, Memon B, Memon M, Abram K (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90(12):1479–1492 PubMedCrossRef
4.
Zurück zum Zitat Simons MP, Aufenacker T, Bay-Nilsen M, Boullot L, Campanelli G, Conze J, Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietansky M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403 PubMedCrossRef Simons MP, Aufenacker T, Bay-Nilsen M, Boullot L, Campanelli G, Conze J, Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietansky M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403 PubMedCrossRef
5.
Zurück zum Zitat Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal preperitoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev. doi: 10.​1089/​lap.​2008.​0212 Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal preperitoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev. doi: 10.​1089/​lap.​2008.​0212
6.
Zurück zum Zitat Leibl BJ, Jager C, Kraft B, Swartz J, Ulrich M, Bittner R (2005) Laparoscopic hernia repair—TAPP or/and TEP? Langenbecks Arch Surg 390:77–82 PubMedCrossRef Leibl BJ, Jager C, Kraft B, Swartz J, Ulrich M, Bittner R (2005) Laparoscopic hernia repair—TAPP or/and TEP? Langenbecks Arch Surg 390:77–82 PubMedCrossRef
Metadaten
Titel
The enhanced view–totally extraperitoneal technique for repair of inguinal hernia
verfasst von
Jorge Daes
Publikationsdatum
01.04.2012
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 4/2012
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1993-6

Weitere Artikel der Ausgabe 4/2012

Surgical Endoscopy 4/2012 Zur Ausgabe

Neu im Fachgebiet Chirurgie

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Chirurgie und bleiben Sie gut informiert – ganz bequem per eMail.