1. LAP TOTAL EXTRAPERITONEAL HERNIOPLASTY
Dr Girish juneja
Head of surgery deptt.
Specialist laparo bariatric surgeon
Al Noor Hospital, abu dhabi, uae

2. TEP
124 case done by single operator in a single standard method to treat all types of inguinal hernias A retrospective analysis of all the laparoscopic total extraperitoneal inguinal hernioplasties (TEP) performed between January 2008 and Nov 2011 was

3. LAP TEP HERNIOPLASTY Mckernan and laws 1993
to avoid possible intra abdominal complications associated with TAPP approach.

4. METHODS Single operating surgeon General anesthesia
Preop. Inj. Ceftriaxone -1 gm iv
Three midline ports.
Balloon dissection was done to create extraperitoneal space in all cases.
Lightweight macroporous partially absorbable Mash 15x 12 cms with fixation at two points medially only

5. Methods
The patients were included in a follow up protocol and were examined 5th day/1 week,1 month & majority of them 1 year . follow up included questions about pain if any , all patients underwent physical examination

6. TEP

7. TEP

8. TEP

9. TEP

11. TEP

12. TEP

16. Demographic characteristics of the patients undergoing surgery for inguinal hernia
Total Extraperitoneal Laparoscopic Inguinal Hernioplasty
Mesh Fixation
Two point medially
(n = 124)
Sex, M/F
122/2
Age, y, mean± SD
16yrs– 72 yrs
Unilateral location
111(89.5%)
Right
88(79.27%)
*Large inguinoscrotal hernias(5)
Left 23
Bilateral
13(10.48%)
Previous surgery 13
Other associated hernia(femoral) 1
Type of unilateral hernia
Direct 19
Indirect
92(82.88%)

17. Demographic characteristics of the patients undergoing surgery for inguinal hernia
Total Extraperitoneal Laparoscopic Inguinal Hernioplasty
Operative time
unilataeral
25- 86(60)mts
bilateral
70-120(90) mts
Hospital admission
1-2 days
post op complications
seroma 5
neuralgia 3
recurrence 4
(all were large inguinoscrotal hernias preop)
infection
Postop scrotal skin ecchymosis

19. Recurrence

20. conclusions
The laparoscopicTEP hernioplasty offers a safe and effective repair with acceptable complication and recurrence rates
Excellent results with the TEP technique can be achieved by laparoscopic surgeons in private hospitals as in specialized hernia centers.
In my experience its suitability for large inguinoscrotal hernias is questionable

21. conclusions
Seroma ,the commonest postoperative complication in this series was treated conservatively as advised in literature but it was noticed that after 1 month if needed aspiration(two cases) was difficult to do, due to septations developed in seroma sac . Therefore advised not to wait longer than 1 month. if seroma not subsided better do aspiration at this stage rather than waiting longer.
Use of dissecting balloon reduces operative time significantly.