Enhanced view totally extraperitoneal approach to irreducible inguinoscrotal and giant inguinal hernias: Technical remarks and 5-year experience

Abstract

Abstract OBJECTIVE: The purpose of this study was to present our 5-year experience of enhanced view totally extraperitoneal (eTEP) approach for irreducible inguinoscrotal and giant inguinal hernias (GIHs), present technical aspects and clinical outcomes in this subset of patients. MATERIALS AND METHODS: This is a retrospective study of 46 patients who underwent eTEP mesh repair for irreducible inguinoscrotal and GIHs from January 2018 to January 2023. The operative steps, difficulties encountered, and tips to perform eTEP in these patients were discussed. RESULTS: The mean age was 54.9 years and the mean BMI was 29 kg/m2. Out of 46 patients, 28 underwent right, 15 left, and 3 underwent bilateral eTEP. Four patients underwent extended totally extraperitoneal-Rives Stoppa (ETEP-RS) for associated umbilical hernia. Four had type 1 GIH with one patient undergoing down to up transversus abdominis release. The mean operating time was 50 min for unilateral, 70 min for bilateral eTEP, and 140 min when ETEP-RS was also performed. We used a minimum size of 13 cm × 17 cm polypropylene mesh. Seroma was seen in eight patients and chronic groin pain in one patient and was managed conservatively. There was no conversion to open or hybrid repair. There were no reoperations or recurrences during the 3-year mean follow-up (3 months–5 years). CONCLUSIONS: eTEP approach is safe, feasible, and offers good outcomes in the management of irreducible inguinoscrotal hernias and GIHs in experienced hands.