Laparoscopic Inguinal Hernia Repair

Posted by e-Medical PPT
How common are they?
 ~ 700,000 inguinal hernia repairs performed in the US per year 
Types: Indirect  &   Direct -- separated by inf epigastric vessels

Open Inguinal Hernia Repairs
Bassini
McVay
Shouldice
Lichtenstein
Plug & patch

Lichtenstein Repair
Popularized the use of polypropylene mesh in primary hernia repairs
Mesh is laid over the undisturbed inguinal floor, posterior to the spermatic cord sutured to the shelving edge of the inguinal ligament, internal oblique fascia and the pubis

Laparoscopic Hernia Repair
When is laparoscopy appropriate?
Recurrent hernias - avoid a prev operated field
Bilateral hernias - one set of incisions better than two inguinal incisions; one mesh to cover both overlay bladder

Types of Laparoscopic Inguinal Hernia Repair
IPOM  (IntraPeritoneal On-lay Mesh) repair. A mesh is placed intra-abdominally covering the hernia defect and then secured to the abdominal wall. Very popular at the beginning of laparoscopic experience, it has since been abandoned.

TAPP   (Trans Abdominal Pre-Peritoneal) repair. With this technique, the pre-peritoneal space is accessed from the abdominal cavity and a mesh is then placed and secured. This is procedure of choice for recurrent inguinal hernias or in case of incarcerated bowel – visualized. 

TEP  (Totally ExtraPeritoneal) repair. The mesh is again placed in the retroperitoneal space, but in this case, the space is accesed without violating the abdominal cavity. This is probably the most physiological repair although technically more demanding.  The procedure of choice for bilateral inguinal hernia repairs

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