**8. Technical details**

for recurrence. Thirteen patients (25.4%) underwent bilateral repair while three (5.8%) patients underwent the same session umbilical hernia repair. The groups were evaluated in terms of operation time, pain scores, recurrence rates, duration of hospitalization and return to daily activity and complication rates. TAPP average operation time is 58 min while in bilateral cases this duration is 72 min. The duration of operation of recurrent cases was 59 min average and there was no significant difference between these patients and the primary cases. A total of 112 patients were treated with TEP technique. Nineteen patients (16.9%) were operated for recurrent hernia, and 14 patients (12.5%) underwent bilateral repair. In three patients (2.6%), the same session umbilical hernia repair was also performed. Average duration of TEP is 47 min while in bilateral cases this duration is observed as elongated, 56 min. The duration of operation in recurrent cases was 56 min and there was no significant difference between these patients and the primary cases. The hospital stay was measured as 1.2 days for TAPP and 1.1 days for TEP, and no significant difference was found between the groups. It was also found that the pain scores between the two groups were similar as 3.2 and 2.9 for TAPP and TEP, respectively. The time to return to the daily activity for TAPP was 5.6 days and for TEP was 5.3 days and no significant difference was found between the two groups. As a complication, seroma in four patients (2.4%), recurrent hernia in two patients (1.2%) and chronic persistent pain in six patients (3.6%) occurred. Patients with recurrence were reoperated. Five patients with chronic persistent pain were treated with medical therapy within 6 months, and one patient with osteitis pubis was detected and curettage was performed by orthopedics clinic. In our study, no significant difference in recurrence, return duration to work, pain score, duration of hospitalization and postoperative complication were detected

The use of laparoscopic methods for inguinal hernia surgery is advanced minimal invasive surgery with less tissue trauma, less postoperative pain, lower postoperative infection risk and faster postoperative recovery. It is possible to combine positive effects such as faster return to work and better cosmetic results. As with all surgical techniques, minimally invasive techniques also have advantages. Compared to open surgery, some disadvantages of inguinal hernia surgery are the initial operation time and the long learning curve. Also, the cost is relatively high. In addition, unlike open surgery, the lack of sense of depth in the image, that is, the operation with the 2D image requires the surgeon to dominate the inguinal region anatomy at a high level. Instead of cost problem, by time, the integration of the learning curve

There are two main techniques when laparoscopic inguinal hernia repair is concerned. These are defined as transabdominal preperitoneal approach (TAPP) and total extraperitoneal approach (TEP). According to the International Endohernia Group's 2011 Guidelines, revised in 2015, TAPP and TEP have become the preferred repair techniques for the Lichtenstein tech-

and the increase in the experience reduce most of the problems.

nique, especially after hernia recurs by open pre-repair [7].

between the groups.

76 Hernia Surgery and Recent Developments

**6. Technical points**
