LAP TOTAL EXTRAPERITONEAL HERNIOPLASTY

Dr Girish juneja

Head of surgery deptt.

Specialist laparo bariatric surgeon

Al Noor Hospital, abu dhabi, uae

TEP

124 case done by single operator in

a single standard method to treat all types of inguinal hernias

A retrospective analysis of all the laparoscopic total extraperitoneal inguinal hernioplasties (TEP) performed between January 2008 and Nov 2011 was

LAP TEP HERNIOPLASTY

Mckernan and laws 1993

to avoid possible intra abdominal complications associated with TAPP approach.

METHODS

Single operating surgeon General anesthesia Preop. Inj. Ceftriaxone -1 gm iv Three midline ports. Balloon dissection was done to create

extraperitoneal space in all cases. Lightweight macroporous partially

absorbable Mash 15x 12 cms with fixation at two points medially only

Methods

The patients were included in a follow up protocol and were examined 5th day/1 week,1 month & majority of them 1 year . follow up included questions about pain if any , all patients underwent physical examination

TEP

TEP

TEP

TEP

TEP

TEP

Demographic characteristics of the patients undergoing surgery for inguinal hernia

Total Extraperitoneal Laparoscopic Inguinal Hernioplasty

Mesh Fixation Two point medially(n = 124)

Sex, M/F 122/2

Age, y, mean± SD 16yrs– 72 yrs

Unilateral location 111(89.5%)

Right 88(79.27%) *Large inguinoscrotal hernias(5)

Left 23

Bilateral 13(10.48%)

Previous surgery 13

Other associated hernia(femoral)

1

Type of unilateral hernia

Direct 19

Indirect 92(82.88%)

Demographic characteristics of the patients undergoing surgery for inguinal hernia

Total Extraperitoneal Laparoscopic Inguinal Hernioplasty

Operative time

unilataeral 25- 86(60)mts

bilateral 70-120(90) mts

Hospital admission 1-2 days

post op complications

seroma 5

neuralgia 3

recurrence 4 (all were large inguinoscrotal hernias preop)

infection 0

Postop scrotal skin ecchymosis

5

Recurrence

conclusions

The laparoscopicTEP hernioplasty offers a safe and effective repair with acceptable complication and recurrence rates

Excellent results with the TEP technique can be achieved by laparoscopic surgeons in private hospitals as in specialized hernia centers.

In my experience its suitability for large inguinoscrotal hernias is questionable

conclusions

Seroma ,the commonest postoperative complication in this series was treated conservatively as advised in literature but it was noticed that after 1 month if needed aspiration(two cases) was difficult to do, due to septations developed in seroma sac . Therefore advised not to wait longer than 1 month. if seroma not subsided better do aspiration at this stage rather than waiting longer.

Use of dissecting balloon reduces operative time significantly.