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Anatomy & technique of the laparoscopic totally extra peritoneal

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Anatomy & technique of the Laparoscopic Totally Extra-peritoneal approch for inguinal hernia repair . DR/ M.M. BOUGHRARA® . 20/4/2017 1
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Anatomy & technique of the Laparoscopic Totally Extra-peritoneal approch for inguinal hernia repair .DR/ M.M. BOUGHRARA®  . 20/4/2017

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Agenda :

Preparation & positioning . Access to pre –peritoneal space . “space creation”. Surgical anatomy . Dissection . Mesh placement .

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•CASE SELECTION :

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CASE SELECTION :

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CASE SELECTION :

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CASE SELECTION :

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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 .

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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 .

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Disadvantages :

Need for general anaesthesia . High cost . Longer duration time . Steeper learning curve . High recurrence and complication

rates early in a surgeon’s experience .

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Idea .

TAPP TEP

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Idea :

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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 .

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Operative planning :

•Preparation .•Postion .

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Steps :

Trocars placement .

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Steps :

Creation of preperitoneal space .

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Steps :

Creation of preperitoneal space .

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Steps :

Creation of preperitoneal space .

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Steps :

Creation of preperitoneal space .

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Steps :

Dissection of hernial sac .

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Steps :

Dissection of hernial sac .

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Steps :

Dissection of hernial sac .

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Stepes :

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Steps :

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Steps :

Placement of mesh .

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Steps :

Placement of mesh .

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Steps :

Placement of mesh .

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Steps :

Placement of mesh .

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Steps :

Placement of mesh .

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Steps :

Mesh fixation .

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Steps :

Mesh fixation .

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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.

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Complications :

Postoperative groin and thigh pain. Miscellaneous complications .

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VIDEO DEMONSTRATION :

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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 .

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THANK YOU…


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