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2017, Number 1

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Rev Mex Cir Endoscop 2017; 18 (1)

Is endososcopic inguinal hernia repair advanced surgery?

Hernández LA

Language: Spanish
References: 18
Page: 23-28
PDF size: 170.41 Kb.


ABSTRACT

Introduction: The most common endoscopic approaches for hernia repair are transabdominal preperitoneal (TAPP), total extraperitoneal (TEP) and extended total extraperitoneal (e-TEP; extended vision TEP). These techniques reproduce the Stoppa principles by placing a large piece of mesh in the preperitoneal space in order to cover completely the Fruchaud or myopectineal orifice, including those potentially herniogenic weak areas, such as the obturator foramen. Material and methods: A search in PubMed Central® was performed (PMC: archives with full texts of biomedical and scientific bibliography in NIH/NLM from the US National Health Institutes), with a specific focus in «learning curves» and «simulators in endoscopic hernia surgery» within the last five years. From the 235 papers shown by the platform, only those with emphasis on the number of cases required to complete with the «learning curve» were chosen. Conclusions: Many surgeons believe that this approach is difficult, since they are not familiar with the pelvic anatomy from a posterior abdominal wall perspective and the working space is just enough for two instruments. This is why it is accepted that a «learning curve» is required to perform a endoscopic hernia repair. The challenge is to introduce this strictly standardized technique in the training programs in order to facilitate for students the memorization and comprehension of the posterior anatomy in its laparoscopic view, including surgical strategies; therefore, the endoscopic hernia repair should be part of basic training programs, including the specific competences to optimize a short «learning curve».


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