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Alam et al. Mini-invasive Surg 2021;5:48 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.65

Review Open Access

Total extraperitoneal hernia repair and its associated

pitfalls

1
Nasra Alam , Aali J. Sheen 1,2
1
Academic Department of Hernia Surgery, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK.
2
Department of Groin Surgery, Fortius Clinic, London W1H 6EQ, UK.
Correspondence to: Prof. Aali J. Sheen, Department of Academic Hernia Surgery, Manchester University, NHS Foundation Trust,
Manchester M13 9WL, UK. E-mail: Aali.sheen@mft.nhs.uk

How to cite this article: Alam N, Sheen AJ. Total extraperitoneal hernia repair and its associated pitfalls. Mini-invasive Surg
2021;5:48. https://dx.doi.org/10.20517/2574-1225.2021.65

Received: 11 Mar 2021 First Decision: 15 Jun 2021 Revised: 16 Jun 2021 Accepted: 16 Jun 2021 Published: 15 Oct 2021

Academic Editors: William W. Hope, Giulio Belli Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Minimally invasive surgery over the last three decades has provided a credible alternative for the treatment of
inguinal hernias. One of the main techniques involved utilises the creation of an extraperitoneal space, thereby
avoiding the need to enter the abdominal cavity. The totally extraperitoneal (TEP) inguinal hernia repair is
described as well as the common and more serious complications that are possible. TEP has a proven track record
of expertise for the surgical treatment of inguinal hernias, but has a steeper learning curve, with more serious
complications such as vascular and bladder injuries, which are explored in more detail. The key to managing any
such serious complications is early recognition. Rectus sheath hematomas secondary to inferior epigastric artery
injury usually require only conservative measures such as close observation with the requirement for any
embolization of any arterial bleed a rare event. Bladder injuries if recognized at the time of surgery require
immediate repair, with late presentation inevitably needing more invasive intervention for a potentially septic
patient. TEP remains an excellent repair with caveats of serious complications which are rare at < 0.5% however,
they must be discussed and be part of the consent process prior to any repair taking place.

Keywords: TEP inguinal hernia, complications of TEP, bladder injuries, inferior epigastric artery injury, rectus sheath
hematoma, bruising, chronic pain

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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