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By Categories: Surgery

Laparoscopic repair – TEP

The Totally Extraperitoneal Repair (TEP) is a keyhole technique for inguinal hernia repair. With this technique, hernias are repaired using a piece of mesh which is placed behind the muscle of the abdominal wall.

The principal advantages of this technique over open surgery are:

  • Less post-operative pain
  • A quicker recovery
  • Faster return to full physical activity

The TEP repair differs from the TAP in that the abdominal cavity is not entered with the laparoscope.  All the surgery is performed in the layers outside the peritoneum.  The risk of bowel injury is therefore less with this technique.

The TEP repair is particularly recommended for the repair of bilateral inguinal hernias and recurrent inguinal hernias.  The procedure is performed under general anaesthesia (Asleep).  Three small incisions are made in the midline between the umbilicus and the pubic bone.

Complications that can occur

  • Pain
  • Bleeding
  • Wound infection
  • Mesh infection
  • Scar
  • Difficulty passing urine
  • Atrophy of the testicle
  • Hernia recurrence
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NGH surgeon gets MBE for amazing work in Africa2024-01-30T11:10:47+00:00

What is a Hernia?2023-03-31T12:53:03+00:00

A hernia is the protrusion of a structure through the wall of the cavity containing it. In the context of this website, a hernia is simply the protrusion of the bowel through a hole or weakness in the muscle layer of the wall of the abdomen.

There are many different types of hernia, named according to the site of the weakness of the abdominal wall. All hernias may gradually increase in size over time. They can be asymptomatic but may cause symptoms of aching or pain. A lump may or may not be palpable. One of the key concerns is the risk of a hernia becoming obstructed or strangulated. The first signs of this are a sudden increase in pain and tenderness of the hernia. The swelling may increase in size and it may not be possible to reduce the hernia, that is to push the swelling back in.

What happens if I don’t have it repaired?2023-03-31T12:52:27+00:00

Hernias do tend to get bigger over time. As they get larger they can become more difficult to repair.  There is a risk that the contents of a hernia may become trapped, called strangulation of the hernia. This is a painful condition which requires urgent surgical attention.

What about exercise after hernia surgery?2023-03-31T12:52:00+00:00

You should resume exercise as soon as possible after surgery.  Please look at the rehab programs for further information. Just start with some gentle walking and you will progress quickly.

Is it a Hernia if it only hurts when I run fast?2023-03-31T12:51:31+00:00

Possibly. A Sportsman’s hernia has a wide variety of presentations, from pain whilst sitting up in bed and coughing, to only being symptomatic when you are running hard. Even then it may not be painful but just give you a sense of instability and lack of power.

Is a Sportsman’s hernia the same as a Gilmore’s groin?2023-03-31T12:51:06+00:00

Yes. The condition known as a Sportsman’s Hernia has many different names. It was first described by Jerry Gilmore in 1980, following the successful treatment of 3 professional footballers with groin symptoms.
Other names for the condition include: Sportsman’s groin, Sportsman’s Abdominal Wall Syndrome, Gilmore’s Groin

How soon can I drive and return to work?2023-03-31T12:50:28+00:00

You should not drive for 48 hrs after any general anaesthetic. After hernia surgery, you are advised to have some time off work to recover.  I normally advise you to plan to return to work 7 -10 days after surgery. If your job involves manual work with heavy lifting, this time may need to be extended to as long as 4 weeks. If your job is desk-based then you may be able to return slightly earlier, but this will depend upon the speed of your recovery.

Could I have a hernia, even if I can’t feel a lump?2023-03-31T12:46:53+00:00

A hernia is most commonly identified as a lump, which gets bigger on coughing and disappears when lying flat. However, this is not the case for some individuals, especially in the sportsman. Sometimes the lump can be challenging to feel on oneself, occasionally the diagnosis is only made after further tests such as ultrasound.

A true sports hernia can be nothing more than a feeling of weakness around the lower trunk. It could be a pain when trying to walk or maybe just running. The presentation is variable, which is why it makes it tough to diagnose if you do not see them very often.

Do all hernias require surgery?2023-03-31T12:47:35+00:00

Surgery is usually advised. Occasionally patients are not fit enough to undergo surgery. If the risk of surgery is considered excessive then it may be suggested that a truss is worn which tries to control the hernia with pressure.

Do I have to have a general anaesthetic?2023-03-31T12:48:33+00:00

No, you do not necessarily need to have a general anaesthetic.  For an inguinal hernia, an open repair can be performed in most instances under local anaesthetic, if you prefer. The laparoscopic technique does require a general anaesthetic.

How do I know if I have a hernia?2023-03-31T12:49:03+00:00

Men and women, young and old, can all have a hernia. Often the first thing you notice is discomfort in the area of the groin, especially when lifting or straining. You might feel a lump in the groin which gets bigger if you cough and can disappear if you lie down.

How do I know if it is a Hernia?2023-03-31T12:49:57+00:00

Sometimes the first symptom is a lump in the groin, other times it is pain or discomfort. Hernias do not account for all groin and abdominal symptoms, and certainly not all of these require surgery.  Many injuries around the groin and abdomen can be treated with physiotherapy alone.

It is always important to rule out other causes of groin pain, including lower back and hip problems. This is the point where an assessment by a Physiotherapist with experience in Hernias and all the associated issues is essential. If there is a true hernia then you will be referred to Rob Hicks for a surgical opinion. If it is not a hernia the actual condition can be addressed with Physiotherapy.

However, if it is a true ‘Hernia’ or ‘Sports Hernia’ then it will not usually resolve without surgery. At The Hernia Clinic, we can offer the most current and appropriate surgical techniques to correct the defect, which is followed up by an integrated rehabilitation package. This will include biomechanical assessment and a graded rehabilitation program.

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