Inguinal hernioplasty had undergone a gradual evolution over the last century: in the beginning the techniques developed were traditional anterior surgical approaches (Bassini, Halsted and McVay). In 1970 surgeons began to use prosthetic material in hernia repair to eliminate tension (Trabucco), since then the inguinal hernioplasty technique has significantly changed. Stoppa and Wantz  applied the mesh to the posterior wall of the groin, developing a new way to approach the hernia repair. The introduction of laparoscopy and the development of new instruments and skills made surgeons further consider the posterior approach for inguinal hernioplasty. The interest in this new technique began in 1990, shortly after the introduction of laparoscopic cholecystectomy: the early pioneers modified the posterior technique, trying to duplicate the steps for the laparoscopic approach but due to inadequate dissection and repair of the entire floor of the groin, recurrence rates of early laparoscopic repair were high. Once it was realized that the laparoscopic technique had to mimic the open posterior mesh repair, the recurrence rate fell below 1% . Most laparoscopic surgeons used the transabdominal properitoneal approach (TAPP) to the inguinal hernia [3, 4]: this technique is more friendly to the laparoscopist because it requires a laparoscopic exposure the extraperitoneal space entering into the peritoneal space. Although the TAPP has now been recognized as a successful technique, a total extraperitoneal approach (TEP) potentially offers some advantages: above all elimination of the complications related to violating the peritoneal cavity in order to reach the extraperitoneal space . Moreover, this technique shortens operative time and allows the easy placement of a large properitoneal mesh in case of bilateral hernias. The TEP approach also seems to be indicated in the treatment of bilateral hernia repairs, because it requires minimal further dissection [2, 3, 6]. At the beginning, the extraperitoneal space dissection might seem difficult but with the initial use of balloon dissectors the exposure will become more easy and safe. The complications related to the TAPP technique are mostly eliminated and the operative time is reduced, although in special circumstances the TAPP approach or open anterior repair are still preferred [3, 7]. After the TEP technique, the patient has a rapid return to normal activities, an exceptional cosmetic and an excellent long-term results for both primary and recurrent hernia.
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