Abstract

Background: Laparoscopic Total Extraperitoneal Preperitoneal Hernioplasty (TEPP/ TEP) is now a proven technique with reduced postoperative pain, rapid recovery, low failure rate, early return to activity/work and better patient satisfaction, but often criticized by rather higher rate of serious complications and recurrence. Patients and Methods: A prospective doctoral research was designed in 2010, and TEPP hernioplasty was performed between 2011 and 2015 under institutional ethics’ approval and written informed consent through posterior rectus approach with 3-midline-port technique. Balloon dissector was used in first three patients. Results: Sixty three adults were recruited. Three females excluded on inclusion criteria. Three males excluded on conversion. TEPP hernioplasty was successfully done in 60 adult male patients with 68 inguinal hernias (unilateral, 52; bilateral, 8). Mean endoscopic vision and ease of procedure were 8.20±1.33 (range 4.0-9.5) and 7.27±2.05 (range 4.0-9.5) respectively. Operation time were 113.4±34.8 (60-205) and 138± 40.2 (90-180) minutes for unilateral and bilateral hernia respectively. Minor complications included inferior epigastric vessel injury (1.5%), excessive CO2 retention (1.5%), surgical emphysema (16.2%), and peritoneal injury (28.3%), portsite infection (6.7%), Seroma (10.3%), temporary orchalgia (1.5%). Conversion rate was 4.8%, and average hospital stay was 3.3±1.7 (1-10) days. Follow up was 33.1±16.9 (5-61) months, which was extended for 43 months beyond the study period. Present study documented zero incidences for both major vascular/visceral complications and long-term recurrence. Conclusions: Present study documented zero incidences for both major vascular/ visceral complications and long-term recurrence. The philosophy of ‘Zero accident vision’ is attainable for TEPP hernioplasty with unhurried technique and dedicated motivation.

Keywords

laparoscopic hernioplasty, total extraperitoneal preperitoneal repair, TEPP, TEP, surgical outcome, clinical outcome, major complications, serious complications, recurrence, zero accident vision, zero vision philosophy, inguinal hernia, recurrent inguinal hernia, femoral hernia