Evidence - Inguinal Hernia Repair by TEP

Indication:

• Recurrent hernia after initial anterior procedure

• Bilateral inguinal hernia

Contraindications:

• Previous procedures in the lower abdomen because this hinders the dissection of the parietal peritoneum off the abdominal wall.

• Scrotal or incarcerated/irreducible hernias

Benefits compared to open mesh procedures (Lichtenstein):

• No difference in mean recurrence rate (2%)

• Less frequent chronic pain

• No postoperative rest required

Drawbacks compared to open mesh procedures (Lichtenstein):

• Surgeon experience has a bigger impact on recurrence rate

• More expensive

• General anesthesia

• More time-consuming

• Major complications possible (injuries to nerves, bowel, vessel, and bladder)

• Drawn out learning curve

Benefits compared to TAPP procedure:

• Adhesions and injury to intraabdominal organs can be avoided

Meshes

• At this time there are not enough clinical data for clear-cut evidence-based recommendation of particular meshes.

• Based on experimental data, we know that heavy-weight meshes are characterized by marked bridging (interfilamentous scarring), more pronounced scarring and therefore shrinkage.

Light-weight meshes, on the other hand, result in less scarring, less bridging and therefore less shrinkage.

• Controlled clinical trials noted more short-term benefits for the light-weight meshes, particularly less seromas, less pain and earlier return to the activities of daily living.

Mesh fixation

• In herniorraphy meshes may be fixated by suture, various absorbable and nonabsorbable tacks, and sealants. • According to the guidelines for minimally invasive inguinal hernia repair (Bittner et al. 2011a) the recurrence rate after TAPP and TEP (evidence level 1B) does not increase when there is no fixation; however, this is only true for defect diameters 3 cm and less. If the mesh is fixated by metal tacks the risk of acute or chronic groin pain may increase. Mesh fixation by fibrin sealant decreases the rate of acute and chronic groin pain without increasing the risk of recurrence.

• In defects up to 3 cm reapired by TAPP and TEP the mesh does not have to be fixated. In larger defects where fixation is deemed necessary, this should be by fibrin sealant since it reduces acute and chronic postoperative pain.

• Only very large medial inguinal hernias, bilateral medial hernias and large scrotal hernias require mesh fixation by tacks. In these case the mesh should be larger sized (12 x 17 cm).

Laparoscopic Inguinal Hernia Repair - Does the Choice of Self-fixated Mesh Matter?

Laparoendoscopic Single-site Versus Three Port Totally Extraperitoneal Hernia Repair: A Prospective Double Blinded Randomized Clinical Trial

Conventional Versus Robot Assisted Laparoscopic Inguinal Hernia Repair

Postoperative Pain and Recurrences After Totally Extraperitoneal Endoscopic (TEP) vs. Lichtenstein Hernioplasty in Female Inguinal Hernia Repair: a Prospective Randomized Multi-center Study

 1. Surg Endosc. 2013 Jul;27(7):2373-82. doi: 10.1007/s00464-013-2797-7. Epub 2013 Feb 7.
A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair.
Bansal VK, Misra MC, Babu D, Victor J, Kumar S, Sagar R, Rajeshwari S, Krishna A, Rewari V.

2. Int J Surg. 2012;10(5):224-31. doi: 10.1016/j.ijsu.2012.03.001. Epub 2012 Mar 24.
A meta-analysis examining the use of tacker fixation versus no-fixation of mesh in laparoscopic inguinal hernia repair.
Sajid MS1, Ladwa N, Kalra L, Hutson K, Sains P, Baig MK.

3. Allgemein- und Viszeralchirurgie up2date 2012; 6(2): 99-115
Prinzipien der minimalinvasiven Chirurgie bei Hernien F. Köckerling, D. Jacob1, S. Grund1, C. Schug-Paß

4. Ann Surg. 2012 May;255(5):846-53. doi: 10.1097/SLA.0b013e31824e96cf.
A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia.
O’Reilly EA, Burke JP, O’Connell PR.

5. Cir Esp. 2011 Oct;89(8):524-531. Epub 2011 Apr 9.
Pain, analgesic consumption and daily life activities recovery in patients undergoing ambulatory totally extra-peritoneal laparoscopic inguinal hernioplasty versus ambulatory Lichtenstein hernioplasty.
Planells Roig M, Arnal Bertomeu C, Cervera Delgado M, Garcia Espinosa R, Sanahuja Santafé A, Carrau Giner M.Unidad de Cirugía, ICAD, Instituto de Cirugía General y Aparato Digestivo, Clínica Quirón de Valencia, Valencia, España.

6. Surg Endosc. 2011 Oct;25(10):3300-6. Epub 2011 May 2.
Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India.
Garg P, Nair S, Shereef M, Thakur JD, Nain N, Menon GR, Ismail M.Department of General Surgery, MM Institute of Medical Sciences & Research, Mullana, Haryana, India.

7. Surg Endosc. 2011 Sep 30.
Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial.
Krishna A, Misra MC, Bansal VK, Kumar S, Rajeshwari S, Chabra A.Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India.

8. Surg Endosc. 2011 Sep;25(9):2849-58. Epub 2011 Apr 13.
A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair.
Teng YJ, Pan SM, Liu YL, Yang KH, Zhang YC, Tian JH, Han JX.Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Dong Gang West Road No. 199, Chengguan, Lanzhou, Gansu 730000, China.

9. Hernia. 2011 Jul 31. [Epub ahead of print]
Author’s reply: bilateral inguinal hernia repair: laparoscopic or open approach? (Hernia 2011; 15:15-18).
Feliu X.Department of General and Laparoscopic Surgery, Hospital General d’Igualada, Avda, Catalunya 11, 08700, Igualada, Barcelona, Spain.

10. Surg Endosc. 2011 Jul;25(7):2330-7. Epub 2011 Feb 7.
A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias.
Shah NR, Mikami DJ, Cook C, Manilchuk A, Hodges C, Memark VR, Volckmann ET, Hall CR, Steinberg S, Needleman B, Hazey JW, Melvin WS, Narula VK.Center for Minimally Invasive Surgery, Ohio State University School of Medicine and Public Health, 548 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210-1228, USA.

11. Langenbecks Arch Surg 2011b; DOI: 10.1007/s00423-011-0875-7
Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques.

12. Hernia. 2011 Jun;15(3):273-9. Epub 2011 Feb 3.
Laparoscopic totally extra-peritoneal inguinal hernia repair: 9 year’s experience.
Swadia ND.Swadia Surgical Hospital, Police Ground Road, Kothi, Baroda, 390001, India.

13. Surg Endosc. 2011 May;25(5):1624-9. Epub 2010 Dec 18.
Follow-up period of 13 years after endoscopic total extraperitoneal repair of inguinal hernias: a cohort study.
Brandt-Kerkhof A, van Mierlo M, Schep N, Renken N, Stassen L.Department of General Surgery, Reinier de Graaf Group, Rotterdam, The Netherlands.

14. J Coll Physicians Surg Pak. 2011 May;21(5):291-6.
Is laparoscopic inguinal hernia repair more effective than open repair?
O A, A G, M J, H WC, Al-Kandari A, S C, M M.University of Aberdeen, United Kingdom.

15. Hernia. 2011 Feb;15(1):15-8. Epub 2010 Oct 21.
Bilateral inguinal hernia repair: laparoscopic or open approach?
Feliu X, Clavería R, Besora P, Camps J, Fernández-Sallent E, Viñas X, Abad JM.
Department of General and Laparoscopic Surgery, Hospital General d’Igualada, Avda, Catalunya 11, 08700, Igualada, Barcelona, Spain.

16. J Long Term Eff Med Implants. 2010;20(2):105-16.
Minimally invasive approaches to inguinal hernia repair.
Leung D, Ujiki MB.Northshore University HealthSystem, Rosalind Franklin University of Medicine and Science, Chicago, IL 60607, USA.

17. World J Surg. 2010 Dec;34(12):3059-64.
Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes.
Myers E, Browne KM, Kavanagh DO, Hurley M.Department of Surgery, St. Luke’s Hospital, Kilkenny, Ireland.

18. J Laparoendosc Adv Surg Tech A. 2010 Jul-Aug;20(6):537-9.
The safety and effectiveness of laparoscopic total extraperitoneal (TEP) repair for recurrent inguinal hernia after open hernioplasty.
Choi YY, Kim Z, Hur KY.Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.

19. Surg Endosc. 2010 Dec;24(12):3026-30. Epub 2010 May 8.
Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature.
Wauschkuhn CA, Schwarz J, Boekeler U, Bittner R.Department for General, Visceral and Thoracic Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, 70199, Stuttgart, Germany.

20. Hernia. 2010 Oct;14(5):477-80. Epub 2010 May 21.
Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5-year review.
Goo TT, Lawenko M, Cheah WK, Tan C, Lomanto D.Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

21. Ann R Coll Surg Engl. 2010 Apr;92(3):201-5.
Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients.
Messenger DE, Aroori S, Vipond MN.Department of General Surgery, Gloucestershire Royal Hospital, Gloucester, UK.

22. Arch Surg. 2010 Apr;145(4):334-8.
Total extraperitoneal laparoscopic inguinal hernia repair without mesh fixation: prospective study with 1-year follow-up results.
Messaris E, Nicastri G, Dudrick SJ.Department of Surgery, Rhode Island Hospital, Providence, 02903, USA.

23. Ann Surg. 2010 May;251(5):819-24.
Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial.
Langeveld HR, van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lange J, Bonjer HJ, Jeekel J.Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.

24. Br J Surg. 2010 Apr;97(4):600-8.
Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair.
Eklund A, Montgomery A, Bergkvist L, Rudberg C; Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) study group.

25. World J Surg. 2010 Apr;34(4):692-6.
The incidence and success of treatment for severe chronic groin pain after open, transabdominal preperitoneal, and totally extraperitoneal hernia repair.
Bright E, Reddy VM, Wallace D, Garcea G, Dennison AR.

26. Surg Endosc. 2009 Jun;23(6):1241-5. Epub 2008 Sep 24.
Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias.
Garg P, Rajagopal M, Varghese V, Ismail M.
Department of General and Laparoscopic Surgery, Fortis Super Speciality Hospital, Mohali, Punjab, 160062, India

27. Surg Endosc. 2009 Mar;23(3):482-6. Epub 2008 Sep 23.
Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years.
Dulucq JL, Wintringer P, Mahajna A.Department of Abdominal Surgery, Maison de Santé Protestante, Bagatelle Hospital, Talence-Bordeaux.

28. Surg Clin North Am. 2008 Oct;88(5):1073-81, vii-viii.
Laparoscopic versus open inguinal hernia repair.
Gould J.University of Wisconsin School of Medicine and Public Health, Department of Surgery, H4/726 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.

29. Zentralbl Chir. 2008 Sep;133(5):433-9. Epub 2008 Oct 15.
[Inguinal hernia: laparoscopic or open surgery?].
Wullstein C, Strey C, Woeste G, Bechstein WO.Klinik für Allgemein- und Gefässchirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main.

30. Surg Endosc. 2008 Aug;22(8):1803-6. Epub 2008 Apr 29.
A 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia.
Staarink M, van Veen RN, Hop WC, Weidema WF.Department of Surgery, Ikazia Hospital, P.O. Box 5009, Montessoriweg 1, 3008 AN, Rotterdam, The Netherlands.

31. Acta Chir Belg. 2008 Jul-Aug;108(4):405-8.
Long-term results of a non-ramdomized prospective mono-centre study of 1000 laparoscopic totally extraperitoneal hernia repairs.
Thill V, Simoens C, Smets D, Ngongang C, da Costa PM.Department of Digestive, Laparoscopic and Thoracic Surgery, C.H.U. Brugmann, U.L.B., Brussels, Belgium.

32. Surgery. 2008 Mar;143(3):313-7. Epub 2008 Jan 14.
Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial.
Hallén M, Bergenfelz A, Westerdahl J.Department of Surgery, Lund University Hospital, Lund, Sweden.

33. Surg Clin North Am. 2008 Feb;88(1):157-78, x.
Laparoscopic inguinal hernia repair.
Takata MC, Duh QY.Division of General Surgery, Scripps Clinic, La Jolla, CA, USA.

34. J Laparoendosc Adv Surg Tech A. 2007 Oct;17(5):585-90.
Laparoscopic totally extraperitoneal hernia repair versus open Lichtenstein hernia repair: results and complications.
Vidović D, Kirac I, Glavan E, Filipović-Cugura J, Ledinsky M, Bekavac-Beslin M.Department of Surgery, University Hospital, Sisters of Charity, Vinogradska 29, 10000 Zagreb.

35. Langenbecks Arch Surg. 2005 Apr;390(2):77-82. Epub 2005 Feb 15.
Laparoscopic hernia repair—TAPP or/and TEP?
Leibl BJ, Jäger C, Kraft B, Kraft K, Schwarz J, Ulrich M, Bittner R.Department for General and Visceral Surgery, Marien Hospital, Stuttgart, Germany.