ETEP

INDICATION
 Recurrent hernia

 Bilateral inguinal hernia

CONTRAINDICATION
 No absolute contraindications

 Obstructed/ strangulated inguinal hernias

 Ascites

 Bleeding disorders
 Anaesthesia- General anaesthesia

 Position- Supine
Steps of TEP

   1. Identify the pubic symphysis in the midline

   2. Bluntly dissect Cooper’s ligament bilaterally. This will open up the space of Retzius

   3. Identify Hesselbach’s triangle and the three potential sites of herniation related to
it (direct, femoral, obturator)

   4. Identify and elevate the epigastric vessels

   5. Bluntly develop the space of Bogros to the level of the ASIS

   6. Dissection of cord structures

   7. Placement of mesh

Transverse infraumbilical incision, with incision in anterior rectus sheath
Stay sutures over incised anterior rectus sheath
Hasson's cannula introduced in subumbilical port
Port placement for totally extraperitoneal mesh repair
Preperitoneal space
Retropubic space after dissection
Left direct hernial defect seen after dissection
Right direct hernial defect
Right indirect hernial sac with cord structures
Dissected and ligated right indirect hernial sac
Rolled prolene mesh
Prolene mesh being placed for repair
THANK YOU