Department of Minimally Invasive, Clínica Bautista, Barranquilla, Colombia.
Surg Endosc. 2012 Apr;26(4):1187-9. doi: 10.1007/s00464-011-1993-6. Epub 2011 Oct 25.
The totally extraperitoneal (TEP) approach for repair of inguinal hernia is the preferred technique since it does not penetrate the peritoneal cavity, thus avoiding potential intraperitoneal complications. The TEP technique allows for regional or even local plus sedative anesthesia, and it gives us an incomparable view of the inguinal region and hernias exactly where they originate. Part of the difficulty with the TEP technique is the limited space it provides for dissection.
We describe a modification of the classical TEP approach which overcomes this limitation: the e-TEP technique. Since October 2010 we have performed 36 e-TEP procedures. Many of these were in difficult cases such as inguinoscrotal and incarcerated hernias and patients with previous radical prostatectomy. We present an initial evaluation of this group of patients.
Results in terms of pain and time off work were the same as with the classical technique. The average operating time was 38 min. This is longer than usual, probably due to the complexity of the cases performed and the time spent in documenting the technique for educational purposes. The peritoneum was often accidentally opened and air leaked into the peritoneal cavity without interfering with the completion of the surgery. We had two small seromas and one case of skin sloughing at the umbilical wound in a case of umbilical and bilateral inguinal hernias. We have had no recurrences, but follow-up has been short.
Our initial experience with the e-TEP technique has been satisfactory. We have had no conversions in spite of the difficult cases selected. There were no major complications, and functional results were excellent. We believe this modification has a place in the armamentarium for hernia repair.
完全腹膜外（TEP）入路修补腹股沟疝是首选技术，因为它不穿透腹膜腔，从而避免潜在的腹腔内并发症。TEP 技术允许区域甚至局部加镇静麻醉，并且为我们提供了腹股沟区域和疝的确切起源的确切视图。TEP 技术的部分困难在于其提供的解剖空间有限。
我们描述了一种改进的经典 TEP 方法，该方法克服了这一限制：e-TEP 技术。自 2010 年 10 月以来，我们已经进行了 36 例 e-TEP 手术。其中许多是在困难的情况下，如腹股沟阴囊和嵌顿疝以及先前接受过根治性前列腺切除术的患者。我们对这群患者进行了初步评估。
疼痛和停工时间的结果与经典技术相同。平均手术时间为 38 分钟。这比通常的时间要长，可能是由于所进行的病例复杂性以及为教育目的记录技术所花费的时间。腹膜经常意外打开，空气漏入腹腔，但不干扰手术的完成。我们有两个小的血清肿和一个脐疝和双侧腹股沟疝病例中脐部伤口皮肤脱落。我们没有复发，但随访时间很短。
我们使用 e-TEP 技术的初步经验是令人满意的。尽管选择了困难的病例，但我们没有转换。没有重大并发症，功能结果非常出色。我们认为这种改良在疝修补术中具有一席之地。
