Hernia repair is one of the most common operations in general surgery.
Indirect hernias protrude with the spermatic cord as it leaves the pelvis, and have a long peritoneal sac.
Direct hernias burst directly through the wall, medial to the epigastric vessels.
Anatomy of the groin:
Left posterior aspect
Right posterior aspect
Posterior aspect of the right inguinal region
Posterior aspect of the left inguinal region
One of the most important advantages of the laparoscopic inguinal hernia repair is placing a large piece of mesh behind the defect covering the myopectineal orifice. As a result recurrence after the laparoscopic repair is lower than open conventional repair.
Natural pressure of the intraabdominal wall keeps the mesh in place
Two most common laparoscopic techniques for inguinal hernia repair are totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair.
Special balloon trocar is inserted above the peritoneal cavity and extraperitoneal insuflation is performed. Dissection of the extraperitoneal space and hernia sack is completed. After that placement of the prolene mesh to the posterior wall of the hernia defect covering all potential hernia sites in the inguinal region is performed. Then the mesh is fixated using special tacker to the Cooper ligament. Desuflation of extraperitoneal cavity is completed at the end of the procedure. Perforation of the peritoneum should be avoided during the dissection.
Trocars are inserted into the peritoneal cavity and peritoneal dissection is performed. Dissection of the hernia sack and placement of the prolene mesh to the posterior wall of the hernia defect covering all potential hernia sites in the inguinal region are performed. Then the mesh is fixated using special tacker to the Cooper ligament and the peritoneum is closed with running suture above the mesh.
The main complications of treatment are vascular injury or visceral injury to intra-abdominal organs, scrotal or trocar-site haematoma, seroma, superficial and/or deep infections, port-site hernia and recurrence. In our series there was no complication.