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General Surgery

Perspective on Hernias (B) Laparoscopic Inguinal Hernia Repair

Built from Maingot's Abdominal Operations

What’s inside

9 sections · 56 slides

  1. 01

    Overview

    • Topics covered

    1 slide

  2. 02

    The laparoscopic operations

    TAPP, TEP and IPOM — what each name means

    • Laparoscopic inguinal hernia repair defined
    • The two commonest laparoscopic repairs
    • Intraperitoneal onlay mesh repair
    • Three laparoscopic approaches
    • Current standing of laparoscopic repair

    5 slides

  3. 03

    Anatomy seen from inside

    The groin as the laparoscope shows it

    • The posterior view of the groin
    • The myopectineal orifice
    • Groin seen through the laparoscope
    • The five nerves lateral to the deep ring
    • Triangle of pain
    • Triangle of doom
    • External iliac artery running toward the groin
    • Corona mortis
    • Bony landmarks of the groin
    • Danger zones around the deep inguinal ring

    10 slides

  4. 04

    Choosing the approach

    Open or laparoscopic, and for whom

    • Open tension-free mesh repair as the standard
    • Costs of the laparoscopic approach
    • Open versus laparoscopic repair
    • Hernias better served by the laparoscopic approach
    • Relative contraindications

    5 slides

  5. 05

    Points of technique

    Where these authors would add emphasis

    • Covering the pubic tubercle in TAPP repair
    • Mobilising the inferior peritoneal flap
    • Handling a large inguinoscrotal sac
    • Slitting the mesh around the spermatic cord
    • Mesh fixation
    • Where not to place tacks
    • Mesh in place after inguinal hernia repair
    • Choosing between TEP and TAPP
    • TAPP in the largest published series

    9 slides

  6. 06

    Published outcomes

    What the trials show, and what they do not

    • Benefits shown in trials and meta-analyses
    • Limits of the published outcome data
    • Veterans Administration cooperative trial
    • 10.1%
    • Implications for patient and surgeon selection
    • The learning curve

    6 slides

  7. 07

    Complications

    Rare, but some are catastrophic

    • Overall morbidity after laparoscopic repair
    • Four sources of complications
    • Major vascular injury during access
    • Sequence of a major vascular injury
    • Managing a suspected major vascular injury
    • Bowel and bladder injury
    • Laparoscopic operating set-up
    • Recurrence after laparoscopic repair
    • Chronic pain after hernia repair
    • Conservative treatment of groin pain
    • When conservative measures fail
    • Ladder of treatment for chronic groin pain
    • Infertility and dysejaculation

    13 slides

  8. 08

    Cost

    Hospital bill versus total cost

    • Hospital cost versus total cost

    1 slide

  9. 09

    Conclusions

    Where the balance falls

    • Conclusions
    • Indications with the widest agreement
    • Summary
    • References
    • References (continued)
    • Maingot's Abdominal Operations, 12th Edition

    6 slides