TEP and TAPP are both minimally invasive laparoscopic techniques for inguinal hernia repair that achieve the same end result: a mesh patch placed in the preperitoneal space behind the abdominal wall to reinforce the hernia defect from behind. The difference is in how that space is accessed. In TEP, Totally Extraperitoneal repair, I work entirely in the space between the inner surface of the abdominal muscles and the peritoneum without ever entering the peritoneal cavity itself. A balloon dilator or surgical dissection creates the working space, and the entire procedure stays outside the peritoneum. This has the advantage of avoiding the peritoneal cavity, which reduces the risk of injury to intra-abdominal organs and the formation of adhesions, though TEP requires a steeper learning curve because the working space is more confined. In TAPP, Transabdominal PrePeritoneal repair, I enter the peritoneal cavity first through three laparoscopic ports, and then incise the peritoneum to access the preperitoneal space where the mesh is placed. TAPP gives a wider working field and is technically more familiar to surgeons who are experienced in standard laparoscopic surgery of the abdomen, and it is particularly useful in patients with previous lower abdominal surgery or complex groin anatomy where the preperitoneal space may be more difficult to develop from the outside. Both techniques produce equivalent long-term recurrence rates in experienced hands and offer the key advantage of laparoscopic over open inguinal hernia repair: bilateral hernias can be repaired through the same three small incisions in a single anaesthetic, with one recovery period rather than two. At Aster CMI Hospital, Sahakar Nagar, Bengaluru, I select TEP or TAPP based on each patient's hernia anatomy, body habitus, and previous surgical history.
Written by Dr. Mahesh Channappa, MBBS, MS (General Surgery), MBA (Healthcare Management), FAIS, FIAGES, FALS (Fellowship in Advanced Laparoscopic Surgery), FMBS (Fellowship in Bariatric and Metabolic Surgery), Da Vinci Robotic Surgery Training, UK NHS 3-Year Structured Surgical Training, Lead Consultant, General and Gastrointestinal Surgery, Bariatric Surgery, Minimally Invasive (Laparoscopic/Robotic) Surgery and Laser Proctology, Aster CMI Hospital, 43/2, NH 7, New Airport Road, Sahakar Nagar, Sanjeevini Nagar, Bengaluru, Karnataka 560092 (Monday to Saturday, 9:00 AM to 4:00 PM). 26+ years. Phone: +91 9620354889 / +91 9844816622.
