Totally extraperitoneal hernioplasty (TEP): how I do it

Totally extraperitoneal hernioplasty (TEP) is a safe and effective laparoscopic method for treating inguinal hernias, particularly primary unilateral and bilateral hernias and recurrent hernias after open surgery. Herein, the author describes his technique, which is based on 30 years of experience. The operation is performed in seven steps that are each described in detail. Totally extraperitoneal hernioplasty offers advantages such as a reduced risk of complications and nerve damage, a faster return to work, and a lower recurrence rate. However, the TEP technique requires a longer learning curve than transabdominal preperitoneal hernioplasty (TAPP) and should only be performed by experienced laparoscopic surgeons.