Surgical repair is the definitive treatment for hernias, with inguinal hernia repair being the most common procedure in the Western world. Various repair techniques, including traditional open repairs and modern laparoscopic methods like total extraperitoneal (tep) repair, have been developed, with tep showing better outcomes for bilateral and recurrent hernias despite its challenging learning curve. Overall, laparoscopic repairs have gained popularity due to their advantages in postoperative recovery and lower complication rates compared to open repairs.

1. Summary
Surgical repair of the hernia is considered to be the only definitive
management of hernia. The outcome of hernia surgery is highly surgeon
dependent "no disease of the human body, belonging to the province of
surgeons requires in its treatment a greater combination of accurate
anatomical knowledge with surgical skill than hernia in all its varieties".
Inguinal hernia repair is the most common general surgical
procedure in the western world. In Sweden alone (population nine
million), an average of 18.000 inguinal hernia operations are performed
annually, of which ∼ 16% are for recurrent hernias.
The exact cause of inguinal hernia is still unknown but the
following factors contribute in its occurrence. A preformed congenital sac
raised intra-abdominal pressure and weak abdominal musculature.
In 1887, Bassini published his original description of inguinal
hernia repair. Later on, many modern modifications such as the Shouldice
repair and the Lichtenstein "tensionless" mesh repair have originated
from it.
Within a decade in the 1990s, laparoscopic enthusiasts had already
described three forms of laparoscopic repairs, namely: the intraperitoneal
mesh (IPOM) repair, the trans-abdominal preperitoneal repair (TAPP),
and the totally extraperitoneal (TEP) repair.
Laparoscopic inguinal hernia repairs, especially total
extraperitoneal (TEP) inguinal hernia repair, have gained ground in the
past few years. TEP is preferred over TAPP as it is less invasive and
preserves the "peritoneal sanctity".
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Summary

2. Prospective randomized trials comparing TEP with open
Lichtenstein repair have shown TEP as a better alternative than open
repair in terms of lesser postoperative pain, earlier ambulation, earlier
return to work and better cosmetic results. However, TEP has a longer and
steeper learning curve due to the "inside out anatomical view", to which
the surgeon is not accustomed.
TEP repair is nearly equal to open repair in the management of
primary unilateral hernia, but it is more time consuming with more
difficulty. However, it is still preferred in cases of bilateral and recurrent
hernias because of lesser tissue trauma and lower incidence of
complications.
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Summary