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Endoscopic repair of a large inguino-scrotal hernia with the e-TEP (enhanced view) technique

J Daes, MD, FACS
Epublication WebSurg.com, Mar 2013;13(03). URL: http://websurg.com/doi/vd01en3928

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  • 2013-03-11
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In this video, we describe the e-TEP (extended view) repair of a left, large, chronic inguinoscrotal hernia in a 35-year-old man. There are two main difficulties in dealing with large inguinoscrotal hernias: the limited surgical field and the management of the distal sac to avoid seroma formation. The e-TEP technique has three principles: a high camera trocar placement, a flexible distribution of trocars, and often the division of the posterior aponeurosis at the level of the line of Douglas. The reasons for this approach are that it facilitates the creation of the surgical space and provides a larger surgical field. This technique has allowed us to expand the indications for extraperitoneal repair of inguinal hernia to large inguinoscrotal hernias, incarcerated hernias and sliding hernias. The description and the results of the e-TEP technique have been published in Surgical Endoscopy (2012). This video shows in detail the dissection of the large indirect sac free from the structures of the spermatic cord and the management of the distal sac to avoid seromas or pseudo-hydroceles by reducing the distal sac and fixing it high and lateral to the posterior inguinal wall. This approach has been recently published in Hernia.