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Since the last few decades, debates have raged in conferences and surgical back alleys as to which procedure is better for inguinal hernias—transabdominal preperitoneal repair (TAPP) or totally extraperitoneal repair (TEP). The issues of contention were—ergonomics, inspection of contralateral groin, management of irreducible hernias, inadvertent peritoneal rent and large sac.
In addition, the consensus generally was—both are acceptable with equally good and safe outcomes and it was essentially left to the surgeon’s comfort [1].
This has changed in recent times. Surgeons employing TEP technique for groin hernia discuss and publish modifying port positions for complex hernias, such as large inguinoscrotal hernias, irreducible hernias, and when the distance from pubis to umbilicus is less [2, 3]. The rationale is to improve the ergonomics for dissection and suturing in these cases. Furthermore, since a future contralateral groin exploration is not technically easy in the event of a hernia, a prophylactic mesh in the contralateral space has been advocated [4, 5].
These recent papers have exposed the limitations of TEP in its various aspects.
Surgeons employing TAPP, on the other hand, have no such concerns and the technique has remained constant. The procedure, by its inherent nature allows, for contralateral inspection, is inherently ergonomically good for suturing, and port positions are standardised. Furthermore, the contents can be reduced under vision with no dilemma of “to cut or not to the sac” to avoid bowel injury especially in a sliding hernia. Furthermore, robotic platforms are now replicating TAPP allowing surgeons to suture with greater ease, hereunto thought to be the disadvantage of TAPP.
The time has come to revisit the debate again, because as of now, it looks like TAPP surgeons are having the last laugh!
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References
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Baig SJ, Priya P, Ahuja A (2020) Modified port positions for totally extraperitoneal (TEP) repair for groin hernias: our experience. Surg Endosc. https://doi.org/10.1007/s00464-020-07620-6
Daes J (2012) The enhanced view—totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26:1187–1189. https://doi.org/10.1007/s00464-011-1993-6
Bochkarev V, Ringley C, Vitamvas M, Oleynikov D (2007) Bilateral laparoscopic inguinal hernia repair in patients with occult contralateral inguinal defects. Surg Endosc 21(5):734–736. https://doi.org/10.1007/s00464-007-9196-x
Zendejas B, Onkendi EO, Brahmbhatt RD, Greenlee SM, Lohse CM, Farley DR (2011) Contralateral metachronous inguinal hernias in adults: role for prophylaxis during the TEP repair. Hernia 15(4):403–408. https://doi.org/10.1007/s10029-011-0784-2
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Baig, S., Khandelwal, N. TAPP surgeons have the last laugh!. Hernia 27, 709 (2023). https://doi.org/10.1007/s10029-023-02798-9
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DOI: https://doi.org/10.1007/s10029-023-02798-9