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PubMed · 1341502

Laparoscopic herniorrhaphy.

A S Seid·H Deutsch·A Jacobson
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Abstract

Laparoscopic preperitoneal prosthetic repair of inguinal and femoral hernias was done in 27 patients, including 18 indirect, nine direct, and two femoral hernias. In four patients bilateral hernias were repaired simultaneously. General anesthesia with endotracheal intubation was used in all patients. Three laparoscopic cannulas were inserted. The peritoneum overlying the internal inguinal ring and floor of Hesselbach's triangle was opened. If an indirect hernia sac was found, it was dissected off the cord structures. A polypropylene prosthesis was used to occlude any potential canal space and to reinforce the pelvic floor. No major operative complications or early recurrences (follow-up, 1-7 months) occurred. Patients were to return to full employment an average of 5 days after surgery (range, 3-7 days).

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Hernia, InguinalHumansLaparoscopyJournal Article

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A S Seid, H Deutsch, A Jacobson. 1992. Laparoscopic herniorrhaphy.. https://pubmed.ncbi.nlm.nih.gov/1341502/

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PubMed2006

Treating recurrence after a totally extraperitoneal approach.

BACKGROUND: One of today's most highly regarded procedures for treating inguinal hernia is the totally extraperitoneal approach (TEP), but it can on occasion lead to recurrence. This is commonly managed with an open repair, a transabdominal preperitoneal procedure (TAPP), or another TEP. We report here on our years of experience with the latter. METHODS: The endeavor to a secondary TEP is much the same as to a primary one, but certain differences are encountered as the operation proceeds. For example, many anatomical landmarks found in a first TEP cannot be seen in a second. There can also be a diminished amount of working space, and this occasionally leads to an open conversion. RESULTS: From September 1991 to September 2005, we repaired 1,526 hernias in 1,156 male patients, using the TEP in every case. Of these, 21 were TEPs after a previous TEP. In 3 cases, the space could not be opened, and they were converted to the open Lichtenstein. One patient had peritoneal tears that led to conversion and another had conversion because of excessive bleeding. There were no complications, no bladder or bowel injuries, no transfusions, no preperitoneal hematomas, and no fatalities. All patients were discharged the same day. CONCLUSIONS: A secondary TEP, open repair, and TAPP are alternative solutions to the problem of recurrence after TEP. However, any TEP involves a very prolonged learning curve for general surgeons, since they must learn the anatomy as well as the procedure, both at the same time. This is doubly true for the TEP after a previous TEP.

Hernia, Inguinal↗