Novel Endoscopic Approach for Repair of Inguinal Hernia – Technical Details and Our Initial Experience

Techniques for the laparoscopic or endoscopic repair of inguinal hernias available so far are of following types: trans abdominal pre peritoneal repair (TAPP), totally extra peritoneal repair (TEP), intra peritoneal onlay mesh repair (IPOM), reduction of hernia contents and sac with narrowing of deep ring, and the extended view totally extra peritoneal repair (e-TEP) technique introduced by Jorge Daes. TEP though based on time tested Rives-Stoppa technique has several limitations, with the introduction of e-TEP approach most of the problems faced in TEP approach were deterred. Ours is a high-volume tertiary care hernia referral center with hernia academy for training young novel surgeons. Since 1994 till August 2018, we were practicing endoscopic repair of inguinal hernias either by TEP or TAPP approaches depending on both operative and patient factors. Between August 2018 and December 2022, we have performed 137 (one hundred thirty-seven) E-TEP inguinal repairs on 90 patients including 47 patients with bilateral defects, all cases were selected randomly. In one patient secondary to obesity and large peritoneal rent, procedure is converted to TAPP. Our initial experience with enhanced view totally extra peritoneal repair (e-TEP) is satisfactory with acceptable results. We have had no conversion to open procedure in spite of few difficult cases selected. There were no major complications except few small postoperative seromas, which were managed conservatively. We believe that the e-TEP approach has a place in armamentarium of hernia surgeries for totally extraperitoneal endoscopic repair of inguinal hernias. Resident surgeons and young novel surgeons will definitely find this technique easier to learn and master.