Surgical Technique of Totally Extraperitoneal Repair (TEP) for an Inguinal Hernia after Operation Using a Lower Abdominal Incision

Toshikatsu Nitta, Jun Kataoka, Takashi Kinoshita, Masato Ohota, Kensuke Fujii and Takashi Ishibashi

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Japan
Department of Surgery, Hirakata City Hospital, Japan

^*Correspondance to: Toshikatsu Nitta 

 PDF  Full Text DOI: 10.25107/2474-1647.1982

Abstract

Introduction: Laparoscopic approaches: Transabdominal Preperitoneal inguinal hernia repair (TAPP) and Totally Extraperitoneal repair (TEP) are alternative to conventional treatment.Surgical Technique: Our TEP after operation, using a lower abdominal incision, is performed under general anesthesia with the patient in supine position. A surgical scar and adhesions on the middle line (after lower abdominal incision) occur in many cases. The abdominal anterior rectus is only cut on the affected side, the abdominal rectus is confirmed, and the abdominal rectus muscle is splinted. Finally, the abdominal posterior rectus is cut, and the extraperitoneal space, including the posterior rectus space, can be easily reached. Dissection can be made without a balloon in the extraperitoneal space. Anatomic landmarks, such as the attenuated posterior rectus sheath, especially the inferior epigastric artery and vein, are important but we can perform the ordinary conventional TEP after reconfirming those landmarks. Same access point. TEP can be performed even if the abdominal adhesions are severe. Our technique is effective, expect when using the lower abdominal incision, due to the postoperative status of prostatic cancer.Conclusion: Postoperative TEP, using the lower abdominal incision, is possible for an inguinal hernia.

Keywords

TEP; Lower abdominal incision; TAPP

Cite the article

Nitta T, Kataoka J, Kinoshita T, Ohota M, Fujii K, Ishibashi T. Surgical Technique of Totally Extraperitoneal Repair (TEP) for an Inguinal Hernia after Operation Using a Lower Abdominal Incision. Clin Surg. 2018; 3: 1982.