Post on 21-Apr-2017
transcript
1
Anatomy & technique of the Laparoscopic Totally Extra-peritoneal approch for inguinal hernia repair .DR/ M.M. BOUGHRARA® . 20/4/2017
2
Agenda :
Preparation & positioning . Access to pre –peritoneal space . “space creation”. Surgical anatomy . Dissection . Mesh placement .
3
•CASE SELECTION :
4
CASE SELECTION :
5
CASE SELECTION :
6
CASE SELECTION :
7
Indications :
Recurrent hernia after previous anterior repair .
Bilateral hernias . Repair of an inguinal hernia
concurrent with another laparoscopic procedure , provided that there is no contamination .
8
Contraindications :
Acutely incarcerated hernias . In patients to whom general
anesthesia may pose an increased risk .
Infant & young children . Previous lower abdominal surgery . Previous pelvic irradiation therapy .
9
Disadvantages :
Need for general anaesthesia . High cost . Longer duration time . Steeper learning curve . High recurrence and complication
rates early in a surgeon’s experience .
10
Idea .
TAPP TEP
11
Idea :
12
13
Avoid injury :1. Inf . Epigastric
vesseles .2. Pectineal lig.3. Ilio-pubic tract
.4. Cut. Nerves on
psoas muscle . 5. Peritoneal
reflection .6. Urogenital
fascia. 7. Vas. &
spermatic vessels .
14
15
16
Operative planning :
•Preparation .•Postion .
17
Steps :
Trocars placement .
18
Steps :
Creation of preperitoneal space .
19
Steps :
Creation of preperitoneal space .
20
Steps :
Creation of preperitoneal space .
21
Steps :
Creation of preperitoneal space .
22
Steps :
Dissection of hernial sac .
23
Steps :
Dissection of hernial sac .
24
Steps :
Dissection of hernial sac .
25
Stepes :
26
Steps :
27
Steps :
Placement of mesh .
28
Steps :
Placement of mesh .
29
Steps :
Placement of mesh .
30
Steps :
Placement of mesh .
31
Steps :
Placement of mesh .
32
Steps :
Mesh fixation .
33
Steps :
Mesh fixation .
34
Complications :
Complications of access……… trocars . injury to bladder , bowel , vessles &
trocars hernia. Complications of dissection ……. Bleeding ,
vas , sp. Vesseles . Complications related to mesh ……… infection , migration , adhesion . Vas deferens and testicular complications.. testicular swelling , orchitis and ischemic
atrophy.
35
Complications :
Postoperative groin and thigh pain. Miscellaneous complications .
36
VIDEO DEMONSTRATION :
37
REFERENCES : Abdominal wall repair center Samaritano Hospital , SAO
PAULO,BRAZIL. Master in minimal access laparoscopic surgery , DR .
Mishra® 2007 . World Laparoscopy Hospital. Philippine Journal of surgical specialities . www.emedicine.medscape.com. HERNIA+ , Modern techniques in hernia repair surgery . AL JALA HOSPITAL, Benghazi , Libya , emergency OT.
2011 . www.medtronic.com >covidien > fixation .
38
THANK YOU…