A COMPARISON OF TRANSABDOMINAL PREPERITONEAL (TAPP) AND TOTAL EXTRAPERITONEAL APPROACH (TEPA) LAPAROSCOPIC HERNIORRHAPHIES

There are a variety of accepted techniques for herniorrhaphy. With the advent of laparoscopic general surgery, laparoscopic transabdominal a nd total extraperitoneal techniques have been added to the many option s for repair of the inguinal hernia. From 5/91 to 6/93 we had performe d 290 transabdominal preperitoneal (TAPP) laparoscopic herniorrhaphies on 244 adult patients. Due to concerns of potential early and late co mplications associated with entering the abdominal cavity, we adopted the total extraperitoneal approach (TEPA) for laparoscopic herniorrhap hies in 6/93. Between 6/93 and 12/93, 118 hernias have been repaired i n 95 patients using the total extraperitoneal approach. In a retrospec tive comparison between these two procedures, the recurrence rate is 1 .7% (5/290) for TAPP herniorrhaphies and 0% (0/118) for the TEPA. The overall complication rate for TAPP herniorrhaphies was 11.1% and inclu ded thigh paresthesias (6), inferior epigastric artery injuries (4), e nterotomy (1), bowel obstruction (1), bladder injury (1), and urinary retention (14). The overall complication rate for the TEPA was 3.2% an d included bladder injury (1), and urinary retention (2). Mean operati ve time was similar between these groups (TAPP-81.2 minutes, TEPA-92.9 minutes).