Lap total extraperitoneal hernioplasty
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LAP TOTAL EXTRAPERITONEAL HERNIOPLASTY. Dr Girish juneja Head of surgery deptt . Specialist laparo bariatric surgeon

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LAP TOTAL EXTRAPERITONEAL HERNIOPLASTY

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LAP TOTAL EXTRAPERITONEAL HERNIOPLASTY

Dr Girishjuneja

Head of surgery deptt.

Specialist laparo bariatric surgeon

Al Noor Hospital, abudhabi, uae


TEP

124 case done by single operator in a single standard method to treat all types of inguinal hernias

A retrospective analysis of all the laparoscopic total extraperitoneal inguinal hernioplasties (TEP) performed between January 2008 and Nov 2011 was


LAP TEP HERNIOPLASTY

  • Mckernan and laws 1993

    to avoid possible intra abdominal complications associated with TAPP approach.


METHODS

  • Single operating surgeon

  • General anesthesia

  • Preop. Inj. Ceftriaxone -1 gm iv

  • Three midline ports.

  • Balloon dissection was done to create extraperitoneal space in all cases.

  • Lightweight macroporous partially absorbable Mash 15x 12 cms with fixation at two points medially only


Methods

  • The patients were included in a follow up protocol and were examined 5th day/1 week,1 month & majority of them 1 year . follow up included questions about pain if any , all patients underwent physical examination


TEP


TEP


TEP


TEP


TEP


TEP


Demographic characteristics of the patients undergoing surgery for inguinal hernia


Demographic characteristics of the patients undergoing surgery for inguinal hernia


Recurrence


conclusions

  • The laparoscopicTEPhernioplasty offers a safe and effective repair with acceptable complication and recurrence rates

  • Excellent results with the TEP technique can be achieved by laparoscopic surgeons in private hospitals as in specialized hernia centers.

  • In my experience its suitability for large inguinoscrotal hernias is questionable


conclusions

  • Seroma ,the commonest postoperative complication in this series was treated conservatively as advised in literature but it was noticed that after 1 month if needed aspiration(two cases) was difficult to do, due to septations developed in seroma sac . Therefore advised not to wait longer than 1 month. if seroma not subsided better do aspiration at this stage rather than waiting longer.

  • Use of dissecting balloon reduces operative time significantly.


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