Effectiveness and Results of the Laparoscopic Total Extraperitoneal Repair (Tep) Method Applied in Inguinal Hernia Surgery: 10 Years of Experience

Year 2024, Volume: 51 Issue: 3, 341 - 350, 19.09.2024

Nevin Sakoğlu , Mehmet Ali Gök , Osman Civil

https://doi.org/10.5798/dicletip.1552484

Abstract

Objective: Laparoscopic Total Extraperitoneal (TEP) hernia repair is frequently performed around the world. Ourgoal here was to evaluate preoperative radiologic findings, intraoperative and postoperative conditions of cases, together with their demographic characteristics, in unilateral, bilateral primary and recurrent cases undergoing hernia operation.
Methods: Between 2011 and 2021, 512 patients were operated for hernia with laparoscopic TEP method. Age, gender, BMI, hernia type, radiologic or peroperative type of hernia, defect size measured during surgery, hernia side, content of hernia, postoperative complications(seroma) of these patients were evaluated retrospectively. Additionally to the expressive statistical procedures (mean, standard deviation) in interpriting and calculating the input, the allocations of the variables were analyzed by the Shapiro-Wilk normality test. Also the independent t test, chisquare test, and logistic regression analysis used. The outcome spicked up were analyzed with p<0.05 meaningful level.
Results: Of 512 cases, 484 (94.53%) underwent unilateral laparoscopic TEP hernia repair and 28 (5.47%) underwent bilateral laparoscopic TEP hernia repair. 467 of the cases were primary and 45 were recurrent. The average ages was47.28±12.41 years. 321 were men (62.70%) and 191 were women (37.30%). The differentiation related to allocation of BMI of Recurrence(-) and Recurrence(+) groups was meaningful (p=0.019). The distinction absolutely was not remarkable between the side allocation of the Recurrence(-) with Recurrence(+) groups(p = 0.217). The presence of indirect hernia (ID) was mostly seen in the Recurrence(+) group(p=0.014). The mean defect size(mm) of the Recurrence(+) group was measured statistically more than the Recurrence(-) group (p=0.015).
Conclusion: The TEP technique is sufficient when performed by experienced surgeons in primary and recurrent cases.

Keywords

laparoscopy, inguinalhernia, TEP, unilateral, bilateral, recurrence

References

• 1.Hernia Surge Group. International guidelinesfor groin hernia management. Hernia. 2018;22:1–165.
• 2.Verheij M, Abdalla A, Chandran P. ComparativeReview of Outcomes of Totally Extraperitoneal(TEP) and Transabdominal Preperitoneal (TAPP)Primary Inguinal Hernia Repair. Cureus2023;15:1-8.
• 3. Miserez M, Peeters E, Aufenacker T, et al. Updatewith level 1 studies of the European HerniaSociety guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18:151–63.
• 4.Ger R, Durvivier R, Mishrick A. A managementof indirect inguinal hernias by laparoscopicclosure of the neck of the sac. Am J Surg.1990;159:370-3.
• 5.Palser TR, Swift S, Williams RN, Bowrey DJ,Beckingham IJ. Variation in outcomes and use oflaparoscopy in elective inguinal hernia repair. BJSOpen. 2019;3:466–75.
• 6.Guillaumes S, Hoyuela C, Hidalgo NJ, et al.Inguinal hernia repair in Spain. A population-based study of 263,283 patients: factorsassociated with the choice of laparoscopicapproach. Hernia. 2021;25:1345–54.
• 7.Hidalgo NJ, Guillaumes S, Bachero I, Holguin V,Momblan D. Trends and predictors oflaparoscopic bilateral inguinal hernia repair inSpain: a population-based study. SurgEndosc.2023;37:4784-94.
• 8.Krishna A, Misra MC, Bansal VK, et al.Laparoscopic inguinal hernia repair:transabdominal preperitoneal (TAPP) versustotally extraperitoneal (TEP) approach: aprospective randomized controlled trial.SurgEndosc. 2012;26:639–49.
• 9.Wei FX, Zhang YC, Wei H, et al.Transabdominalpre-peritoneal (TAPP) versustotally extraperitoneal (TEP) for laparoscopichernia repair: a meta-analysis. Surg LaparoscEndosc Percutan Tech. 2015;25:375–83.
• 10.Chen LS, Chen WC, Kang YN, et al. Effects oftransabdominal preperitoneal and totallyextraperitoneal inguinal hernia repair: an updatesystematic review and meta-analysis ofrandomized controlled trials. SurgEndosc.2019;33:418–28.
• 11.Bittner R, Montgomery MA, Arregui E, et al;İnternational Endohernia Society. InternationalEndohernia Society Update of guidelines onlaparoscopic (TAPP) and endoscopic (TEP)treatment of inguinal hernia (InternationalEndohernia Society) Surg Endos. 2015;29:289-321.
• 12.Miserez M, Peeters E, Aufenacker T, et al.Update with level 1 studies of the EuropeanHernia Society guindelines on the treatment ofinguinal hernia in adult patients. Hernia.2014;18:151–63.
• 13.Pisanu A, Podda M, Saba A, Porceddu G,Uccheddu A. Meta-analysis and review ofprospective randomized trials comparinglaparoscopic and Lichtenstein techniques inrecurrent inguinal hernia repair. Hernia.2015;19:355-66.
• 14.Saini V, Varshini RA, Rathore YS, et al.Perioperative complications of laparoscopicinguinal hernia repair in India: a prospectiveobservational study. J Minim InvasiveSurg2023;26:190-97.
• 15.Köckerling F, Koch A, Lorenz R, et al. How Long Do We Need to Follow-up Our Hernia PatientstoFind the Real Recurrence Rate? Front Surg. 2015; 2:1-5.
• 16.Burcharth J, Pommergaard HC, Bisgaard T,Rosenberg J. Patient-related risk factors forrecurrence after inguinal hernia repair: asystematic review and meta-analysis ofobservational studies. SurgInnov 2015;22:303-17.
• 17.Köckerling F, Schug-Pass C. Tailored approachin inguinal. Hernia repair -decision tree based onthe guidelines. Front Surg. 2014;1:20.
• 18.Aiolfi A, Cavalli M, Del Ferraro S, et al. Totalextrapertoneal (TEP) versus laparoscopictransabdominal preperitoneal (TAPP)hernioplasty: systematic review and trialsequential analysis of randomized controlledtrials. Hernia 2021;25:1147-57.