TAPP Hernia Repair by Ipsilateral Port
11 months ago
This video demonstrate TAPP (Transabdominal Preperitoneal Inguinal Hernia) Repair by Ipsilateral Port. The indications for laparoscopic inguinal hernia repair, TAPP or TEP, are the same for open inguinal hernia repair. They may be ideal for bilateral inguinal hernias and recurrences from anterior approaches but is also appropriate with unilateral primary hernias when the surgeon is comfortable with the technique. For young, active males with primary hernias, it may ofter decrease pain and an earlier return to activity. Prior to lower abdominal surgery or pelvic radiation is strong relative contraindications, as these may make access to the preperitoneal space difficult. The hernia is visualized, and the peritoneum overlying it incised sharply. Blunt dissection can be used to peel the peritoneal flaps inferiorly, exposing the inferior epigastric vessels, the pubic symphysis and the Cooper’s ligament, and the iliopubic tract. A direct hernia should be reduced if seen, and an indirect dissected from the cord structures. Femoral and obturator hernias can also be visualized and reduced. Care is taken to avoid the “Triangle of Doom” containing the external iliac vessels bordered by the vas deferens medially and the gonadal vessels laterally. A mesh ranging from 10 to 15 cm in diameter of polypropylene or polyester is introduced through the optical trocar and positioned anterior along the pelvic wall with the center over of the primary hernia defect.