[Total extraperitoneal endoscopic hernioplasty (TEP) in the treatment of incarcerated and irreponible inguinal and femoral hernias].

To estimate the value of TEP in the treatment of incarcerated and irreponible inguinal and femoral hernias more exactly we prospectively collected and evaluated the data of our clinic for the period of Oct. 1999 until Dec. 2003. In this period we performed in total 1 671 hernia repairs including 79 patients suffering from an incarcerated (n = 33) or irreponible (n = 46) inguinal or femoral hernia. Using only the TEP-technique we treated mainly the irreponible hernias (46 patients). In the combination of LAP (laparoscopy) and TEP (27 patients) the laparoscopy provided the possibility to classify as well the incarcerated tissue as the result of the reposition. With this combined technique we treated the majority of the incarcerated hernias. To confirm the recovery of the incarcerated tissue laparoscopy can be of high value at the end of the combined LAP + TEP (2 patients). Thus TEP was performed in 92 % of the cases. In 2 cases we performed a conventional hernioplasty and one operation was finished conventionally after switching from endoscopic to conventional procedure. In 2 patients we performed a laparoscopically supported resection of the incarcerated tissue without patch implantation. 1 patient acquired TAPP. The use of different operative techniques and their combinations demonstrates as well the possibility as the necessity of a differentiated and case adapted proceeding in the treatment of incarcerated hernias. Lethality with 1.2 % and early postoperative morbidity with only 5.0 % were low. The hospitalisation period was 4.7 d on average. Our results are comparable to results of literature and show that TEP-technique and combined TEP + LAP-technique are possible and reasonable for the treatment of incarcerated and irreponible hernias.