hernia laparoscopic treatment, southlake texas
TRANSCRIPT
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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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