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Laparoscopic Inguinal Hernia Repair

Contents
Overview
Anatomy
Technical Analysis
Laparoscopic Mesh
Instruments
OR Set-up
Trocars
Consent
Coding-Billing
TAPP Technique
TEP Repair
Post-op instructions
Mngt. Complications
Oucome Analysis
Photos
References

Emails and Questions

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Laparoscopic Repair of Inguinal & Femoral Hernias
Overview

The laparoscopic repair of inguino-femoral hernias has had a tumultuous beginning in the surgical arena. Laparoscopic repairs have had to compete with the current gold standard for anterior or conventional inguinal hernia repairs. Initially, some of these laparoscopic repairs, such as the "plug and patch" (PAP) and "on lay technique" (IPOM ), failed to demonstrate good results and were abandoned. Only two laparoscopic repairs have proven to be viable with early results comparable or superior to the Liechtenstein repair. These repairs are the Extraperitoneal Laparoscopic Repair (TEP) and the Trans-Abdominal Preperitoneal Repair (TAPP). Some authors are now claiming newer and simpler open laparoscopic inguinal hernia repairs such as "Plug" or "Klug" Repair are effectively competing with the laparoscopic inguinal hernia repairs without the increased cost. On our surgical service, the laparoscopic inguinal hernia repair remain the best surgical modality for the management of inguinal hernia. It is however a sophisticated technique whose performance remains linked to the laparoscopic experience of performing the surgeon.

Currently, the two most popular laparoscopic techniques are the TAPP and the TEP.  

The most ardent critique of the TAPP procedure is that it is an intra-abdominal procedure with significant potential morbidity. On the other hand, the TEP procedure  avoids intra-abdominal access. In our studies, the morbidity rate of both these laparoscopic repairs was minimal and/or similar to other open repairs with comparable early recurrence rates. The most persuasive argument for using this procedure is the same argument favoring all laparoscopic procedures: the postoperative benefits to the patients, i.e., less postoperative pain, decreased disability and small incisions. However, it continues to be a procedure with limited long term follow-up and analysis. We strongly believe surgeons performing laparoscopic inguinal hernia repair should be familiar with the TEP and TAPP Repair.

Our surgical team developed an original TAPP repair in the early nineties. This original technique was modified on several occasions. Later, the TEP technique was introduced for patients who had previously undergone major lower abdominal surgery. As of August 1, 2001, over 2300 repairs were performed. Our technique and results are herein reported.

 
 


 

Procedural Videos
> Full TAPP Repair [Female}

>Full TAPP Repair [Male]

>Full TEP Repair [Male]

>Repair of Complications in TEP Repairs

> Repair of Complications in TAPP Repair

> Inserting and Using the TEP Balloon and Structural Trocar.

>Anchoring the Mesh Techniques in TAPP and TEP Repair

> TEP or TAPP: How to decide?


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