腹股沟疝TEP

Present Video shows a case of 45 year old men, food heatlh condition, with symtomatic right inguinal hernia. Main complain was pain after exercices. Laparoscopic surgery was performed, done a TEP repair, During the surgery i found a large indirect sac, difiicult to reduce. After isolation of the cord structures from the sac, i performed a sac ligation with external endoloop. At the end a 15x14cm prolene mesh was placed. I reviewed the placement of the mesh using peritoneal view.

Some Personal considerations of Inguinal/Femoral/Obturatory Hernias:

I prefer laparoscopic repair of inguinal hernia over open techiniques because:
- Less tissue damage (in open surgery there's much more tissue damage and higher chance of chronic pain
- Smaller visible cutaneous scar.
- Can threat 4 kinds of hernia: inguinal - Direct and Indirect, Femoral and Obturatory. In open surgery, the lichtenstein hernia repair (most used of open techiniques) only threat Direct and Indirect types of hernia, that can increase the recurrence.
- Can be done with good results with regular prolene mesh (lower cost).

Why I Like Total Extraperitoneal Techinique (TEP) in comparison with Trasperitoneal Preperitoneal Repair (TAPP):
- Less invasive techinique of inguinal/femoral/obturatory hernia repair
- Lower Cost: no need of tacking devices (avoid chronic pain in the long run). Can be done without dissection baloon (high cost device).
- No need to open the peritoneum under the mesh (avoid adhesions, internal bowel hernias, intestinal fistulas when compared to TAPP)
- Better angle of vision (on TEP you don't have to worry with bladder on the medial side of the field)

When i don't recommend TEP:
- Note that those are not contraindications: Previous lower abdomen surgeries: caesarean surgery, prostatectomy / radiotherapy of the pelvic region. In these cases i indicate Trasperitoneal Preperitoneal Repair (TAP) or open techinique. Some surgeons are performing Extended TEP (E-TEP), and don't have problem with those contraindications above, but i never done that techinique.

When i indicate open surgery:
- Failure of previous TEP / TAPP repair.
- High risk patient (can't handle general anesthesia for any reason. i don't recommend TEP or TAPP without general anesteshia, those techiniques requeries good muscular relaxation).

Side Note:
- For laparoscopic thechiniques: usually i don't indicate vesical catheter for young patients (male age below 60 years). I ask them to urinate just before the surgery). If they have difficulty to urinate, or are older, or with big size hernias, i indicate urinary catheterization. I remove the catheter at the end of the procedure. I also ask the anestesiologyst to infuse smallest possible amount of saline.

- There isn't a universal "best techinique" for all patients. Some will be better threated with TEP, others with TAPP, and a fewer number with open techinique. The indication of what type of techinique is individual for each patient.

                               
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- Usually i use 15x14cm mesh for each inguinal region. Very large defects, i can use bigger meshs or can suture the mesh on the cooper ligament to avoid recurence.