Totally extraperitoneal inguinal hernia repair (TEP)

TEP Repair

The requirement for surgery is the patient’s tolerance for general anesthesia. TEP repair used to be performed with regional anesthesia. Nowadays the surgeons use general anesthesia but with transition from the regional. Sometimes anterior repair under a regional or local anesthetic is required for patients, who don’t tolerate general anesthesia due to comorbidities.

TEP repair might become difficult because of surgeries performed earlier in the preperitoneal space, such as retropubic prostatectomy and TEP. Using space-creating balloons (which function not quite properly when dense adhesions are present in the space of Retzius ) can make the surgery easier. Holes in the peritoneum often appear in reoperative preperitoneal surgery. Patients who undergone preperitoneal operation should choose TAPP when it comes to laparoscopic repair or anterior repair through an unadulterated plane.

According to some surgeons previous open appendectomy is a contraindication for TEP repair for patients with right inguinal hernias. There might be some complications in lateral dissection caused by the appendectomy scar. However, a safe and effective TEP repair may be performed.

Another elements that can complicate TEP repair are previous low midline incisions, but the surgery still can be performed. Sometimes access to the preperitoneal space might have to be moved to a more lateral location rather than the standard location in the midline. If the surgeon managed to achieve the access the operation proceeds correctly. However, the rate of visceral injury is higher for patients with previous low laparotomies.