Trans Abdominal Pre Peritoneal Hernia Repair by Ipsilateral Port
Hernia Surgery is one of the most common laparoscopic surgery performed by a general surgeon. Prosthetic mesh has recently been used in the operative management of laparoscopic inguinal hernia and has been shown to significantly reduce recurrence as compared with traditional anterior hernia repair without mesh.
Although recurrence rates remain the most important outcome parameter, other variables, such as postoperative pain and discomfort, have attracted more attention as interest shifts to the postoperative quality of life after laparoscopic hernia surgery. Recently, discussions on laparoscopic inguinal hernia repair focus more on better ergonomics to facilitate better dissection, rather than the rate of recurrence.
Several studies have shown that laparoscopic repair offers the advantage of minimally invasive surgery to the patient. Doing laparoscopic hernia surgery by ipsilateral port gives better ergonomics to the laparoscopic surgeon. Ipsilateral port Trans Abdominal Preperitoneal placement of the mesh has the advantage of using the intra-abdominal pressure to push the mesh against the overlying fascia in a more natural type of repair and decreases postoperative chronic pain because it prevents contact with the inguinal sensory nerves, ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerve, running in the inguinal canal. Polysoft mesh is a moderate-pore polypropylene mesh with a memory-ring consisting of polyester. The memory-ring offers easy deployment of the patch in the preperitoneal space during open anterior mesh repair.
Developments in laparoscopic ipsilateral port position techniques to repair inguinal hernias using polypropylene flat mesh have led to valuable options for the management of inguinal hernias. Laparoscopic repair is associated with less postoperative pain, prompter return to normal activities, and less chronic pain than classic open, tension-free, mesh hernia repair. Currently, most laparoscopic repairs of inguinal hernias are performed by placement of a mesh into the preperitoneal space. However, the use of the ipsilateral port position for transabdominal preperitoneal (TAPP) hernia repair has not been reported previously. We report the results of a study evaluating the feasibility, safety, and effectiveness of TAPP inguinal hernia repair using Ipsilateral port in the video shown above.
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