Description
Laparoscopic Extraperitoneal Inguinal and Ventral Hernia Repairs is a minimally invasive surgical approach that avoids entering the peritoneal cavity, reducing postoperative complications and recovery time. This technique is particularly beneficial for patients with bilateral or recurrent hernias, as it offers excellent visualization and access with minimal tissue disruption. Inguinal and ventral hernias can be effectively treated using the extraperitoneal route, which allows for precise mesh placement and a lower risk of adhesions. This session will cover indications, procedural steps, and the advantages of this technique over traditional open or intraperitoneal approaches.
Summary Listen
- Laparoscopic TAP (Transabdominal Preperitoneal) and TEP (Totally Extraperitoneal) hernia repairs are discussed, highlighting TEP as a preferred approach due to its anatomical correctness, avoiding intra-abdominal risks and complications associated with TAP. Open hernia repair is still important for training, especially in case of conversions from laparoscopic procedures.
- TAP's advantage is thorough intra-abdominal examination, but disadvantages include difficult retromuscular plane identification, gas insufflation issues, and potential injury to abdominal structures. TEP avoids these issues by working in the preperitoneal space, utilizing CO2 for dissection, though it requires precise anatomical knowledge and can be challenging to learn.
- The robotic approach to TEP allows for enhanced visualization and precise dissection. Key anatomical considerations in laparoscopic hernia surgery include the triangle of doom, triangle of pain, corona mortis, and the course of the ilioinguinal and genitofemoral nerves.
- Fixation methods for meshes are crucial, and the use of glue is favored to minimize chronic postoperative pain associated with tacks or sutures. Recurrences can be addressed with tailored surgical approaches based on individual patient needs, and previous surgery type.
- E-TEP (Extended View TEP) is presented as an advanced technique revolutionizing hernia surgery, offering a large surgical field and flexible port placement. Key landmarks for E-TEP include Douglas line, and surgeons should recognize the "lump sign" and neurovascular bundles.
- ITE (eTEP for Umbilical Hernias and Diastasis Recti) offers an approach to repairing umbilical hernias and diastasis recti by expanding the preperitoneal space. Surgeons progress from TAP, to TEP, to E-TEP, then ITE.
Sample Certificate
About the Speakers
Dr. Savvas Hirides
Clinical Assistant Professor, University of Nicosia, Cyprus
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