What are the contraindications for totally extraperitoneal (TEP) laparoscopic inguinal hernia repair?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

To undergo TEP repair, patients must be able to tolerate general anesthesia. Although TEP repair has been performed with regional anesthesia, [48, 49] it is most commonly performed with general anesthesia, and transition from regional to general anesthesia might be required. Patients whose comorbidities preclude general anesthesia should undergo anterior repair under a local or regional anesthetic.

Previous operations in the preperitoneal space (eg, retropubic prostatectomy and TEP) can make TEP repair difficult. TEP is usually facilitated by using space-creating balloons, which generally function poorly when dense adhesions are present in the space of Retzius. Holes in the peritoneum are common in reoperative preperitoneal surgery. A better choice for laparoscopic repair in patients who have previously undergone a preperitoneal operation is TAPP; an anterior repair through an unadulterated plane may be an even better option.

Some surgeons consider previous open appendectomy a relative contraindication for TEP repair in patients with right inguinal hernias. [28] On occasion, the appendectomy scar complicates the lateral dissection, but this does not preclude a safe and effective TEP repair.

Previous low midline incisions can also make TEP repair more difficult, though not impossible. Access to the preperitoneal space might have to be moved to a more lateral location rather than the standard location in the midline. Once access is achieved, TEP repair usually proceeds as normal in patients with previous low laparotomies, though some studies report a higher rate of visceral injury in these cases.


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