A Comparative Evaluation of Extended Total Extraperitoneal Repair Versus Standard Total Extraperitoneal Repair and Transabdominal Preperitoneal Repair of Inguinal Hernias

BACKGROUND AND OBJECTIVES: Laparoscopic inguinal hernia repair (LIHR) includes transabdominal preperitoneal repair (TAPP), standard totally extraperitoneal repair (TEP), and now extended TEP (eTEP). However, there is still a paucity of well conducted, peer reviewed comparative studies regarding the advantages, if any, of eTEP. This study aimed to compare the data of eTEP repair with that of TEP and TAPP repair. METHODS: Two hundred twenty patients were randomly assigned to one of three groups of eTEP (80), TEP (68), and TAPP (72) after matching for age, sex, and clinical extent of hernia. Permission of ethics committee was taken. RESULTS: Comparison with TEP showed, mean operating time for eTEP was significantly longer in the first 20 patients, subsequently there was no difference. Conversion rates of TEP to TAPP was significantly higher. The other peroperative and postoperative parameters did not differ. Similarly, on comparison with TAPP, there was no difference in any of the parameters. eTEP, also had shorter operating time and less incidence of pneumoperitoneum when compared to published TEP and TAPP studies. CONCLUSION: All the three laparoscopic hernia approaches had similar outcomes. eTEP cannot be advocated as a substitute for TAPP or TEP.The choice of procedure should be the surgeon’s choice. However, eTEP does combine the advantage of both TAPP, in the form of a large working space and of TEP, by being totally extraperitoneal. eTEP is also easier to learn and teach.