Daes J

Language: Spanish
References: 6
Page: 118-122
PDF size: 155.29 Kb.

ABSTRACT

The favored laparoscopic approach for the repair of an inguinal hernia is the totally extraperitoneal (TEP) repair due to the fact that there is no incursion in the abdominal cavity therefore lessening the risk of visceral injury and limiting the formation of adherences thus lessening the possibility of small bowel occlusion. This technique also permits the use of local anesthesia with sedation. The TEP technique provides an excellent view of the structures in the inguinal region and of the hernias that occur in this space. It reproduces the Rives & Stoppa technique. The technique has gained popularity as surgeons become more familiar with the anatomy of the inguinal and the technique itself has become standardized. The technique is indicated in: primary inguinal hernias, bilateral hernias, recurrent hernias after an anterior approach, possibility of a coexisting inguinal-femoral hernia, and repair of hernias in patients who need a quick recovery. Absolute contraindications are: when the surgeon does not have experience in the technique, when the patient has an unacceptable surgical risk. Relative contraindications are: previous pelvic surgery (especially retroperitoneal), patients ASA III or IV and cases with incarcerated or strangulated hernia. In our service we have made a modification of the TEP technique to compensate for its primary disadvantage which is a limited surgical field. This modification which we denominate e-TEP (e for extended), compensates for this great disadvantage creating an ample surgical field and permits flexible port-site placement, these elements are useful in big inguino-scrotal hernias, incarcerated hernias, in obese patients and in patients with a short distance between umbilicus and pubis. The technique will also aid the novice surgeon in performing the technique.

REFERENCES

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