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2011, Number 3

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Rev Mex Cir Endoscop 2011; 12 (3)

Inguinal plasty: laparoscopic totally extraperitoneal (TEP) approach

López CJA, Guzmán CF, Miranda LMA, Cabral Á

Language: Spanish
References: 17
Page: 103-107
PDF size: 74.26 Kb.


ABSTRACT

Introduction: The laparoscopic approach (LA) is the best choice in most of the abdominal pathologies, there are some exceptions such as the inguinal hernia repair. Since 1992 when the trans-abdominal-pre-peritoneal (TAPP) and the totally-extraperitonal (TEP), LA emulate the inguinal hernia repair with posterior open approach, satisfactory results are obtained. According to international reports, the LA indications are bilateral hernia, recurrence and diagnostic doubt. Learning curve: The number of procedures that are required to surpass the learning curve is controversial, for there are reports of 30 to 300 surgeries. Surgical technique TEP LA: It is a priority to have knowledge of the posterior inguinal region. It is best choice to standarize the procedure in steps: Step 1. Identify the mid-line and the Cooper ligament. Step 2. Making space of endopelvic fascia and cefalization of the abdominal cavity. Step 3. Dissection of the hernial sack and its structures. Step 4. Mesh colocation. TEP LA Indications: It depends on the abilities and experience of the surgical team, but the most recommended due to small work space are: direct Hernia, femoral, Nyhus indirect I and II, bilaterals and recurrents with anterior characteristics. Results: Our results posterior to the learning curve are similar to those reported in international literature: Morbidity of 3.7% and recurrences minor than 1%. Conclusion: To justify the TEP LA in the inguinal repair the following requisites must be covered: Surgical time, complications and recurrences similar to open approach, but offering the advantages of LA such as minor post-op pain, minor chronic pain, fast reincorporation to activities and cosmesis. To accomplish this, a long learning curve is required.


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