Conversion of Total Extraperitoneal (TEP) to Transabdominal Preperitoneal (TAPP) for repair of inguinal hernia; Frequency and causes.

  • Muhammad Ghayasuddin Hamdard College of Medicine and Dentistry.
  • Fareya Usmani Sir Syed College for Medical Sciences for Girls.
  • Imran Munir Bahria International Hospital Karachi.
  • Mahwash Anjum Shafiq Dow University of Health Sciences, Karachi.
  • Syed Muhammad Sheraz Raza Naqvi Dow University of Health Sciences Karachi.
Keywords: Hernia Repair, Inguinal Hernia, TEP, TEPP, Total Extra Peritoneal, Trans Abdominal Preperitoneal Inguinal Hernia Repair


Objectives: Our study aims to determine the incidence of and reasons for the conversion of hernia operations from laparoscopic guided total extraperitoneal (TEP) to transabdominal preperitoneal inguinal hernia repair (TEPP). Study Design: Cross-sectional study. Setting: A large tertiary care hospital in Karachi Pakistan. Period: From August 2016 to November 2018. Material & Methods: The sampling technique utilized was consecutive non-probability sampling. The study population consisted of patients between the ages of 22 and 50 years, males, having unilateral inguinal hernia, both direct and indirect presentation. A complete history and physical examination was performed and recorded in a pre-designed proforma for all the patients. Laboratory investigations were performed per routine. The patients underwent laparoscopic total extraperitoneal hernia repair and were noted for complications and conversion to transabdominal preperitoneal inguinal hernia repair. Data was analyzed using IBM SPSS statistics version 20. Chi-square test was used to analyze categorical variables, while mean and percentages were used for numerical data. A p value of less than 0.05 is considered to be statistically significant. Results: The study population was n= 150, mean age of the patients was 36.25 +/- 7.08 with a minimum of 22 and a maximum of 50 years. The direct hernia was present in 47.33% (71 patients) while an indirect hernia was present in 52.67% (79 patients). Out of the total patient population, 21 (14%) of the patients (having a p-value of 0.013) were converted to the TAPP procedure of which 10 (14.08%) has a direct hernia and 11 (13.92%) had an indirect hernia respectively (having a p-value of 0.953). The most common reason for conversion was peritoneal tear, hemorrhage and instrument failure. Conclusion: According to the results of our study, 14% of cases of direct and indirect hernia had to convert from TEP to TAPP procedure, and the main reasons for this conversion were found to be hemorrhage, peritoneal tear and instrument failure.

Author Biographies

Muhammad Ghayasuddin, Hamdard College of Medicine and Dentistry.


Assistant Professor General Surgery


Fareya Usmani, Sir Syed College for Medical Sciences for Girls.

MBBS, FCPS (General Surgery)

Assistant Professor General Surgery

Imran Munir, Bahria International Hospital Karachi.


Professor and Head Neurosurgery

Mahwash Anjum Shafiq, Dow University of Health Sciences, Karachi.

MBBS, FCPS (General Surgery)

Senior Registrar


Syed Muhammad Sheraz Raza Naqvi, Dow University of Health Sciences Karachi.


House Officer Surgery