Inguinal Hernia - Lap vs Open - TAddona

Inguinal Hernia - Lap vs Open - TAddona - Laparoscopic...

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Unformatted text preview: Laparoscopic Inguinal Hernia Laparoscopic Inguinal Hernia Repair: Art or Evil Inguinal Hernias Inguinal Hernias How common are they? ­ ~ 700,000 inguinal hernia repairs performed in the US per year Inguinal Hernia Inguinal Hernia Types: Indirect & Direct ­­ separated by inf epigastric vessels Open Inguinal Hernia Repairs Open Inguinal Hernia Repairs Bassini McVay Shouldice Lichtenstein Plug & patch Lichtenstein Repair Lichtenstein Repair Popularized the use of polypropylene mesh in primary hernia repairs Mesh is laid over the undisturbed inguinal floor, posterior to the spermatic cord sutured to the shelving edge of the inguinal ligament, internal oblique fascia and the pubis Laparoscopic Hernia Repair Laparoscopic Hernia Repair When is laparoscopy When is laparoscopy appropriate? Recurrent hernias ­ avoid a prev operated field Bilateral hernias ­ one set of incisions better than two inguinal incisions; one mesh to cover both overlay bladder Types of Laparoscopic Inguinal Types of Laparoscopic Inguinal Hernia Repair IPOM (IntraPeritoneal On­lay Mesh) repair. A mesh is placed intra­ TAPP (Trans Abdominal Pre­Peritoneal) repair. With this technique, the TEP (Totally ExtraPeritoneal) repair. The mesh is again placed in the abdominally covering the hernia defect and then secured to the abdominal wall. Very popular at the beginning of laparoscopic experience, it has since been abandoned. pre­peritoneal space is accessed from the abdominal cavity and a mesh is then placed and secured. This is procedure of choice for recurrent inguinal hernias or in case of incarcerated bowel – visualized. retroperitoneal space, but in this case, the space is accesed without violating the abdominal cavity. This is probably the most physiological repair although technically more demanding. The procedure of choice for bilateral inguinal hernia repairs Trochar placement for both Trochar placement for both TEP & TAPP Anatomy Anatomy What does the literature say ? What does the literature say ? Comparison of Conventional Anterior Surgery and Laparoscopic Surgery for Inguinal­Hernia Repair Mike S.L. Liem, M.D., Yolanda van der Graaf, M.D., Cees J. van Steensel, M.D., Roelof U. Boelhouwer, M.D., Geert­Jan Clevers, M.D., Willem S. Meijer, M.D., Laurents P.S. Stassen, M.D., Johannes P. Vente, M.D., Wibo F. Weidema, M.D., Augustinus J.P. Schrijvers, Ph.D., and Theo J.M.V. van Vroonhoven, M.D. Multicenter randomized prospective trial Sample: 487 (TEP­mesh); 507 (open­no mesh) Postop f/u 1 & 6 weeks, 6 mo, 1 & 2 years Conclusion: Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair Liem et al. Comparison of Conventional Anterior Surgery and Laparoscopic Surgery for Inguinal­Hernia Repair. NEJM. 1997. 336. 1541­7. Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia Leigh Neumayer, M.D., Anita Giobbie­Hurder, M.S., Olga Jonasson, M.D., Robert Fitzgibbons, Jr., M.D., Dorothy Dunlop, Ph.D., James Gibbs, Ph.D., Domenic Reda, Ph.D., William Henderson, Ph.D., for the Veterans Affairs Cooperative Studies Program 456 Investigators VA Multicenter randomized prospective study N: 3518 (eligible) 2164 (randomization) 1983 (surgery) 1696 (2 yr f/u) Conclusions Conclusions Higher recurrences in laparoscopic group for primary (same for recurrence repairs) Increased intra­op/postop complications in the laparoscopic group Earlier return to usual activities in lap. Group **Recurrence rates for lap surgeons threshold was 250 repairs** Leigh Neumayer, M.D Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia. NEJM. 2004; 350:1819­27 Limitations Limitations VA population Variability among surgeons performance Surgeons experience was self­reported Leigh Neumayer, M.D Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia. NEJM. 2004; 350:1819­27 ...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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