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Comparative Study
. 2025 Aug 9;25(1):355.
doi: 10.1186/s12893-025-03105-2.

A retrospective comparative study of the enhanced view-totally extraperitoneal technique versus the traditional totally extraperitoneal technique in managing recurrent inguinal hernias

Abdullah Hilmi Yilmaz  1 , Mehmet Esref Ulutas  2
Affiliations
Comparative Study

A retrospective comparative study of the enhanced view-totally extraperitoneal technique versus the traditional totally extraperitoneal technique in managing recurrent inguinal hernias

Abdullah Hilmi Yilmaz et al. BMC Surg. .

Abstract

Background: International guidelines recommend a laparoscopic approach in patients with recurrent inguinal hernia after open anterior repair. It is unclear which laparoscopic approach should be used. The aim of the study was to evaluate the safety and efficacy of the laparoscopic enhanced view-total extraperitoneal (eTEP) technique and total extraperitoneal (TEP) technique in the treatment of recurrent inguinal hernias.

Methods: The retrospective cohort study compared patients with unilateral recurrent inguinal hernia after anterior repair who underwent eTEP or TEP technique from February 2023 to February 2024. The two groups were compared in demographic characteristics and surgical and postsurgical data. The primary outcome of this study was recurrence and operation time.

Results: A total of 62 patients were analyzed. The eTEP technique was performed on 32 patients, while the TEP technique was used on 30 patients. The mean follow-up period was 18.3 (± 5) months. There was no recurrence in either group. The mean operative time was 44.4 (± 10.4) minutes for the eTEP group and 45.7 (± 10.2) minutes for the TEP group (p = 0.62). Pneumoperitoneum occurred in 14 (43.7%) patients in the eTEP group and 20 (66.7%) patients in the TEP group (p = 0.07). The mean time to return to activities was 6.8 (± 2.7) days for the eTEP group and 6.9 (± 2.3) days for the TEP group (p = 0.57). Chronic pain was reported in only 1 (3.3%) patient in the TEP group (p = 0.48). The length of stay in the hospital was 1 day for both groups. Hematoma formation was observed in 3 (9.3%) patients in the eTEP group and 3 (10%) patients in the TEP group; seroma formation was reported in 2 (6.2%) and 2 (6.7%) patients, respectively (p = 0.99).

Conclusion: The eTEP technique demonstrated results similar to TEP, particularly regarding recurrence, operation time, and postoperative outcomes. Like TEP, eTEP is a safe and viable option for recurrent inguinal hernias. Furthermore, prospective randomized studies comparing these two techniques are necessary for recurrent inguinal hernias.

Keywords: Recurrent; Recurrent inguinal hernia repair; eTEP.

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Conflict of interest statement

Declarations. Consent for publication: Not applicable. Competing interests: The authors would like to affirm that they have no conflicts of interest to disclose. Ethics approval: All procedures conducted in studies involving human participants adhered to the ethical standards set forth by the institutional research committee, as well as the 1964 Helsinki Declaration and its subsequent amendments or other comparable ethical guidelines. The University of Health Sciences at Van Training and Research Hospital’s ethics committee granted approval for the study on November 29, 2024. Consent to participate: Written informed consent was obtained from all participants involved in this study, ensuring that the ethical standards of research were upheld.

Figures

Fig. 1
Fig. 1
eTEP’s port positioning plan
Fig. 2
Fig. 2
Potential hernia sites and structures. (Yellow circle: Indirect hernia area, Green circle: Direct hernia area, Blue circle: Femoral hernia area, Blue star: Inferior epigastric vessels, White star: Ductus deferens, Yellow star: Testicular vessels, Red star: Pubic bone, Green star: Iliac artery, Black star: Iliac vein)
Fig. 3
Fig. 3
TEP’s port positioning plan
Fig. 4
Fig. 4
Flow diagram
See this image and copyright information in PMC

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