Hernia Laparoscopic Treatment, Southlake Texas

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• Ahernia is defined as an abnormal protrusion of an organ or

tissue through a defect in its surrounding walls.

• Groinhernia

• Inguinal

• Direct

• Indirect

• femoraL

• The inguinal canal is an oblique space measuring 4

cm in length that lies above the medial half of the

inguinal ligament.

• Inguinal canal has 4 walls : anterior, posterior, roof, and

floor

• Males : spermatic cord and ilioinguinal nerve

• Females : round ligament and the ilioinguinal nerve

• Uncomplicated hernias requireeither :

• No treatment

• Support with a truss

• Operative treatment

• complicated hernias :

• always require surgery, oftenurgently.

• For any hernia the surgical option comprises 2 components :

• Herniotomy

• Herniorrhaphyor hernioplasty

• It is either :

•Openrepair

Bassini repair

Shouldice repair

Tension freemesh repair

• Laparascopic repair

• Bilateral inguinal hernia

• When the diagnosis of inguinal hernia is uncertain

•When the patient want to return to normal physical life

Laparoscopic repair is done by 2 approaches :

1. Transabdominal preperitoneal “TAPP”

2. Totally extraperitoneally “TEP”

• The patient medical condition makes general

anesthesia more risky

• Patient who have planned pelvic or extraperitoneal

operations (eg, radical prostatectomy)

• Patient who have had a recurrence froma prior

laparoscopic repair

• Patient presented with strangulated hernia

• Less acute postoperative

pain

• Shorter convalescence

• Earlier return to work

DISADVANTAGES

• increased risk of femoral

nerve injury and

• Increased risk of spermatic

cord damage

• risk of developing

intraperitoneal adhesions

with theTAPP

• greater cost and duration of

the operation

• The TAPPapproach, first described by Arregui and

colleagues in 1992

• It requires laparoscopic access into the peritoneal

cavity and placement of mesh in the preperitoneal

space after reducing the hernia sac.

• The first TEPinguinal hernia repair was described by

McKernan and Laws in1993.

• This approach involves preperitoneal dissection and

mesh placement without entering into the abdominal

cavity.

• Urinary retention

• Nerve injury

• Testicular ischemia and atrophy

• Injury to vas deferens

• recurrence

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