LAPAROSCOPIC TAPP/TEP HERNIA REPAIR WITH MESH IMPLANT- Thsi is the quickest way of repair and getting into active working lifestyle. This surgery is scarless and small 4 cuts of 1 cm are taken on abdomen to insert the laparoscope in the hernia site. Then a mesh is implanted into the hernia defect and surgery is done. This will help to get back to work earlier as chances of pain are almost nil afer surgery. Safe and recommended to young women and men.
Indicated in :-Inguinal/Groin,Umbilical,Small incisional hernias
Laparoscopic inguinal hernia repair uses an instrument called a laparoscope. Between two and four small incisions are made through the abdominal wall through which are passed the laparoscope (a thin telescope with a light on the end) and surgical instruments into the abdomen. The incisions are small, so the whole technique is often called keyhole surgery. (Conventional surgery is called open surgery.)
It is also often referred to as minimally invasive or minimal access surgery.The hernia is then viewed from inside the abdomen, from the other side of the abdominal wall.
The abdominal cavity is inflated with carbon dioxide gas to give the surgeon space to work inside the patient and the actual operating is done remotely with long instruments.
The hernia defect or hole is covered with mesh from within the abdomen and staples commonly fired through it into the muscle tissue in order to fix it as a patch.
So when would Keyhole Hernia Surgery be recommended?
If there has been a previous failed open repair, particularly if mesh was used ‘unsuccessfully’ or perhaps, inexpertly.
In certain incisional hernia cases where laparoscopy is deemed more appropriate
In certain cases involving hernia on both sides (a bilateral hernia) and both are to be repaired at the same time
On a per-case basis where it is felt that the balance of factors indicate that laparoscopy would be the better option
It is technically demanding for the surgeon. What that really means is that its difficult to learn and difficult to do well. He has to practice a great deal and perform a large number to become really good at it.
Due to the nature of operating by using a 2D video image of the site rather than proper 3D visualisation there is the risk of major organ damage (blood vessel, bowel and bladder).
Keyhole repairs have to be done under general anaesthesia. That carries risks on its own and certainly not so good if you are elderly or have other medical conditions.
In practice and depending upon how it is performed, you can get quite a lot of pain after a laparoscopic inguinal hernia repair, because the pain does not come from the skin cut anyway. The pain is more likely to be related to the fact that the deep tissues have been cut and pulled, and staples may have been used to fix the mesh.
An infraumbilical incision is used to access the peritoneal cavity and a 10-12 mm trocar placed. An angled scope (30 degrees or more) is ideal and is used to place two 5 mm ports either in the midline below the umbilicus or in the midclavicular line bilaterally. The hernia is visualized, and the peritoneum overlying it incised sharply 3-4 cm superiorly from the medial umbilical ligament to the anterior superior iliac spine.A mesh ranging from 10 to 15 cm in diameter of polypropylene or polyester is introduced though the subumbilical trocar and positioned anterior along the pelvic wall with the center over of the primary hernia defect.
The operative layout of the total extraperitoneal repair is identical to the TAPP approach. The infraumbilical incision in the anterior fascia is made lateral to the linea alba, and the rectus muscle retracted laterally, exposing the posterior rectus sheath. A balloon dissector can be used, or the laparscopic camera, to open up the preperitoneal space under direct visualization. A sutured repair of the defect, or a Veress needle in the upper abdomen to release intra-abdominal pneumoperitoneum, can maintain the preperitoneal working space. If this is not successful, conversion to a TAPP repair would be appropriate.