Comparative Review of Outcomes between Enhanced View Totally Extraperitoneal Technique with Inherently Divided Douglas’ Line and Totally Extraperitoneal Technique for Repairing Inguinal Hernia

Abstract

Background:The inguinal hernia can be repaired using a variety of laparoscopic methods. The most popular procedures are transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). TEP technique is regarded closet to ideal. However, it has limitations that inspired the evolution of e-TEP. This small e stands for enhanced or extended view. Although the division of Douglas' line is not inherent to e-TEP technique, it offers a wider working place for secondary ports. Objective: To compare extended view totally extraperitoneal repair with inherently divided Douglas' line to totally extraperitoneal repair of inguinal hernia concerning operative time, ease of the procedure and postoperative complications. Patients and Methods: This prospective cohort study enrolled 55 patients diagnosed with inguinal hernia underwent laparoscopic repair between January 2019 and November 2021. Thirty-one patients (56.4%) underwent e-TEP technique with inherently divided Douglas' line (group I) and twenty-four patients (43.6%) underwent TEP technique (group II). Results: No significant difference was found between the two groups regarding age, sex and body mass index. Overall complication rate was higher in TEP group than in e-TEP group. Mean operative time, hospital stay, and pain score were less in e-TEP technique with inherently divided Douglas' line. The number of used tacks, and early return to work were significantly different for favor of e-TEP group. Conclusion:Enhanced view TEP technique with inherently divided Douglas' line is superior to TEP technique for repairing inguinal hernia in providing a better visual angle and ergonomics with lower complication rates and shorter operative time