Lap Inguinal Hernia Repair (TEP and TAPP)

Lap Inguinal Hernia Repair (TEP and TAPP)

Protrusion of small intestine through the tender poriton in the groin is referred as inguinal hernia. Inguinal hernia is not usually seen in women. Usually hernia does not cause any serious concern. But at times it may grow in size and cause serious problems to the affected person. Activities like walking, running and taking part in physical exertion can increase the pain, swelling and inconveniences caused by hernia. Hernia cannot be controlled by any medication or treatment options. This can be rectified only through surgical procedures.
Before deciding to carry out the surgical procedure, your physician will study your medical history and conduct a physical examination to ascertain how much the hernia has developed. He will also inform you which of the medications that you are taking now has to be stopped for making you fit for the surgery to be performed. There are two common types of surgical procures for finding out solutions to the problems caused by hernia. They are Trans abdominal preperitoneal (TAPP) and Total extra preperitoneal (TEP). These procedures can be carried out through laparascopic surgeries.

Transabdominal preperitoneal (TAPP)

TAPP is the most suitable surgical procedure for bilateral hernia as both the hernias can be accessed and required corrections can be done through one set of incisions. Through a small incision the surgeon inserts a laparoscope into the abdomen of the patient. With the help of the camera connected to the laparoscope the surgeon is able to view the organs he is operating, in the monitor placed in the operation theater. Seeing these video he carries out the surgery. The laparascope and other instruments for surgery have to be inserted very carefully as it may injure the abdominal parts.
Patients who have some problems with anesthesia are not suitable for this type of surgery. Another contraindication is coagulopathy which means the inability of the body mechanism for the clotting of blood. Bigger hernia and history of previous surgery in the pelvic or abdominal region are relative contraindications. In this procedure the peritoneal cavity is accessed and the bulging small intestine is pushed back to its proper place. It is secured there by placing a wire mesh so that the hole is closed and the intestine will not fall back again.

Merits of TAPP

  • Bilateral hernias can be corrected in single surgery
  • Anatomy can be visualized in a better way
  • Mesh can be placed in proper position securely

Demerits of TAPP

  • Abdominal cavity is transgressed
  • Takes more time for the completion of the procedure.

Total extra peritoneal(TEP)
As the name implies the peritoneal cavity is not violated in this case. Through small cuts in the hernia area a laparascope is inserted and surgery is done by the surgeon viewing the images through a video monitor placed near to him. In this surgery the surgeon lifts the bulging small intestine to its original position and the vulnerable portions are made stronger with the help of synthetic mesh.

Merits of TEP

Abdominal cavity is not transgressed
1 q Operative space can be accessed very easily


Peritoneum will be torn
1 Poor visibility of the anatomy


Dr. Nagaraj B Puttaswamy

Senior Consultant - Laparoscopic Surgeon Bariatric Surgeon and Surgical Gastroenterologist