Laparoscopic surgery is now worldwide accepted to treat groin hernias. Transabdominal PrePeritoneal (TAPP) approach is one of the possible techniques. With this technique, the surgeon works in a familiar environment, can treat bilateral hernias, and confirm/diagnose hernias missed in the preoperative examination.
The main indications are bilateral hernias and recurrent hernias from an anterior approach. However, TAPP repair has several advantages I believe support its systematic use. Using the TAPP repair prosthesis is placed in a preperitoneal fashion that increases the success of the repair. TAPP repair covers the entire myopectineal orifice. Chronic postoperative pain becomes a rarity. Surgical site infection decreases to near-zero levels (prosthesis is far away from the incisions). Finally, patients' recovery is faster. Although hollow viscera perforation, injury to major vessels and the Corona Mortis, and bladder perforation are possible complications, they are rare. TAPP repair is safe and feasible.
Working with my friend Prof. Dr. Jaime Vilaça, procedure steps became even clearer. I have to say thanks to him for the essential and valuable tricks and tips. This new video shows a direct inguinal hernia treated by TAPP using a non-adhesive mesh fixed with tackers. Care is necessary when placing the tackers: avoid Corona Mortis when fixating to Cooper's ligament; place tackers above the iliopubic tract (escape from the triangle of doom and triangle of pain). Nowadays, we are using an auto adhesive mesh so that no fixation is necessary.
Assist the video using one of the two links bellow. Enjoy!
Link to YouTube:
Link to Surgical Videos:
Dr. Carlos Eduardo Costa Almeida
General Surgeon