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20 th international laparoscopic surgery symposium , January 24, 25, 26, 2013

20 th international laparoscopic surgery symposium , January 24, 25, 26, 2013 S. F. C. E. 2013 MEETING . Inguinal hernia repair: Minimal open preperitoneal approach: MOPP (Grid iron- TIPP techniques) Marc Soler , Cagnes sur Mer – France. Henri R Fruchaud, 1956.

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20 th international laparoscopic surgery symposium , January 24, 25, 26, 2013

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  1. 20th international laparoscopic surgery symposium , January 24, 25, 26, 2013 S. F. C. E. 2013 MEETING Inguinal hernia repair: Minimal open preperitoneal approach: MOPP (Grid iron- TIPP techniques) Marc Soler, CagnessurMer – France

  2. Henri R Fruchaud, 1956 • The surgicaltreatment of inguinal or femoralhernias must not be the closure of the inguinal canal or the femoral ring, but the « deep reconstruction » of the abdominal wall in the whole groin region • Surgical Anatomie of groin herniaSurgicaltreatment of groin hernia

  3. The NyhusPreperitonealRepair, 1955-1960

  4. JEAN Rives 1965

  5. René Stoppa Giant prosthetic reinforcement of the viscéral sac 1967: First tension free and sutureless hernia repair

  6. 1992 Transperitonealapproach J. Leroy, G. Fromont Properitonealapproach G. Begin, JL Dulucq Mini-invasive ACCESS surgery But not minimale invasive surgery - generalanesthesia -technique iscomplex -highcost of instrumentation -vascular and visceral complications

  7. J.H. ALEXANDRE1981- INGUINAL APPROACH-CORD PARIETALISATION - M. P. O. OVERLAPPING

  8. Grid iron: Franz Ugahary 1995

  9. TIPP: 2005Edouard Pélissier 4. Pélissier Hernia. 2001 5. Pélissier Hernia. 2006

  10. TIPP 2005 scrotal « approach » 6. Berrevoët et al. Hernia. 2009

  11. TIPP TECHNIQUEJ.F. Gillion

  12. TECHNIQUE MOPP- UGAHARY

  13. TECHNIQUE MOPP-TIPP

  14. TECHNIQUE MOPP-TIPP

  15. SPECIFIC MATERIAL

  16. Marc Soler: CagnessurmerFrom 2001 To 2012:N =1675 (1450 patients) - 2001 TO 2009: regular flat mesh, and Light weight meshes: 1375 cases Ugahary (GRID IRON ) -2009 TO 2011: New expandable mesh: 200 cases Ugahary, (Grid Iron) - 2011:New mesh TIPP technique and gridiron: 200 cases

  17. MINIMALE PREPERITONEALE TECHNIQUE (MOPP) J.H. ALEXANDRE UGAHARY (GRID IRON TECHNIQUE) TIPP ( Trans InguinalePrePeritoneale technique)

  18. MOPP TECHNIQUEConclusion • Total groin hernia repair primary & secondary hernia • Minimal invasive • Minimal access • Local anesthesia, • Complication  no conversion

  19. Conclusion • Surgical Technique No nerves dissection No prosthesis on the contact of the nerves No material to fix the prosthesis

  20. MOPP TECHNIQUEConclusion The self expandable mesh, Make easier to unroll the prosthesis in the Preperitoneal space. PROSPECTIVE STUDY - Post operative pain/ QOL - recurrence rate

  21. Conclusion SURGEON Hernia dedicated knowledge of preperitoneal anatomy surgical training INSTRUMENTATION regular surgical instruments long anatomical forceps a pair of small long blade, curved base retractors MESH Polypropylen mesh, large size

  22. WHY TO CHOOSE POSTERIORAPPROACH ? BECAUSE WE HAVE LESS SEVERE CHRONIC PAIN

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