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PubMed · 8771318

Laparoscopic extraperitoneal herniorrhaphy.

L G Collins
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Abstract

Laparoscopic extraperitoneal (LEP) herniorrhaphy procedures allow direct visualization and repair of many types of hernias (e.g., direct, indirect, femoral, sliding, bilateral). Common complications of open herniorrhaphy procedures are avoided when LEP herniorrhaphy procedures are used because the peritoneum is not entered. The placement of synthetic mesh in the preperitoneal space during LEP herniorrhaphy procedures prevents inadvertent contact with peritoneal contents and minimizes patients' risks of adhesions, bowel obstructions, fistulas, and intraabdominal vascular injuries. Improved anatomic presentation and optimal patient outcomes are achieved with this approach.

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Hernia, InguinalHumansLaparoscopyMalePerioperative NursingSurgical MeshJournal Article

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L G Collins. 1996. Laparoscopic extraperitoneal herniorrhaphy.. https://doi.org/10.1016/s0001-2092(06)63295-x

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PubMed2006

Treating recurrence after a totally extraperitoneal approach.

BACKGROUND: One of today's most highly regarded procedures for treating inguinal hernia is the totally extraperitoneal approach (TEP), but it can on occasion lead to recurrence. This is commonly managed with an open repair, a transabdominal preperitoneal procedure (TAPP), or another TEP. We report here on our years of experience with the latter. METHODS: The endeavor to a secondary TEP is much the same as to a primary one, but certain differences are encountered as the operation proceeds. For example, many anatomical landmarks found in a first TEP cannot be seen in a second. There can also be a diminished amount of working space, and this occasionally leads to an open conversion. RESULTS: From September 1991 to September 2005, we repaired 1,526 hernias in 1,156 male patients, using the TEP in every case. Of these, 21 were TEPs after a previous TEP. In 3 cases, the space could not be opened, and they were converted to the open Lichtenstein. One patient had peritoneal tears that led to conversion and another had conversion because of excessive bleeding. There were no complications, no bladder or bowel injuries, no transfusions, no preperitoneal hematomas, and no fatalities. All patients were discharged the same day. CONCLUSIONS: A secondary TEP, open repair, and TAPP are alternative solutions to the problem of recurrence after TEP. However, any TEP involves a very prolonged learning curve for general surgeons, since they must learn the anatomy as well as the procedure, both at the same time. This is doubly true for the TEP after a previous TEP.

Hernia, Inguinal↗