Laparoscopic totally extra-peritoneal inguinal hernia repair: 9 year's experience

Abstract

Purpose: Major innovations continue to occur in the operative techniques used in hernia operations. Laparoscopic totally extra-peritoneal (TEP) hernia repair is the latest addition to the long list of operations used for hernia repair. The objectives of this study were to assess the safety and efficacy of this relatively new procedure and to discuss various technical aspects to make the procedure easy to learn.

Methods: Patients who underwent elective inguinal hernia repair from January 2000 to December 2008 were included in this ongoing prospective clinical study. Patient demographic data, operative records, perioperative findings, postoperative morbidity and outpatient follow-up of TEP repairs were studied.

Results: Out of 1,814 hernia operations, 1,539 (84.84%) were performed by laparoscopic TEP repair and 275(15.16%) were operated by Lichtenstein repair. There were 19 conversions from attempted TEP to open surgeries. Mean operative time for unilateral TEP repair was 28 ± 7 min and for bilateral repair 36 ± 8 min The incidence of intra-operative complications was 2.98%. Overall morbidity rate was 8.57%. The usual hospital stay was 36 h. The recurrence rate in first 3 years was 8.00%, the next 3 years, 2.05% and in the last 3 years, 0.67%. The longest interval between operation and recurrence was 48 months.

Conclusions: Laparoscopic TEP repair is an excellent mode of treatment in the era of laparoscopic surgery. If the standard technique now established is followed, the procedure is easy to learn for a laparoscopic surgeon, the overall morbidity and complications are fewer in number and severity, and recurrence rates are lower.