No other laparoscopic procedure has been the source of controversy as much as the laparoscopic approach to inguinal hernias. The two common laparoscopic techniques include the transabdominal preperitoneal repair (TAPP) and the total extraperitoneal repair (TEP). We present our experience with a novel technique by combining the two ideas of TAPP and TEP to get benefit of both techniques. We compared the operative time and the need for mesh fixation of the new technique with that of the standard TAPP technique.

From May 2009 to July 2011, a total of 335 patients complaining of indirect inguinal hernia were included in this study. We have operated on 137 patients with new technique of combined TAPP and TEP (first group). The other 198 patients were operated with the standard TAPP technique (second group). All patients who had the new modified technique were operated by a single surgeon in a university-affiliated hospital.

All procedures have been finished laparoscopically with no conversion. The average operative time was 39.8 minutes for the first group and 44.3 minutes for the second group. Mesh was fixed in 30 patients (21.9%) of the first group and 81 patients (40.9%) of the second group. Postoperative port site infection in the first group occurred in 3 patients (2.19%). No perioperative morbidity or mortality occurred.

Combined TAPP and TEP is safe and feasible. It simplifies the procedure; makes operative time significantly less with lower rate of recurrence as well as decreases the need for mesh fixation.

Abou EL-Nagah GMM. Combined TAPP and TEP: A New Modified Technique for Laparoscopic Inguinal Hernia Repair. World J Lap Surg 2012;5(2):72-75.