Laparoscopic inguinal and femoral hernia repair in adults
- George A Sarosi, Jr, MD
George A Sarosi, Jr, MD
- Robert H. Hux Professor
- Department of Surgery
- University of Florida College of Medicine
- Kfir Ben-David, MD, FACS
Kfir Ben-David, MD, FACS
- Vice Chairman of Surgery
- Chief of Gastroesophageal Surgery
- Mount Sinai Medical Center
Minimally invasive surgical approaches are increasingly popular because they offer the potential for less postoperative pain and a quick return to normal activities. Laparoscopic repair of inguinal and femoral hernia is no exception, with laparoscopic approaches first used to treat inguinal hernias in 1992 . The learning curve for laparoscopic hernia repair is prolonged with estimates ranging between 50 and 100 procedures. However, when performed by an experienced surgeon (>100 repairs), hernia recurrence is low .
Laparoscopic repair of inguinal and femoral hernias is discussed here. The classification and diagnosis of inguinal and femoral hernias, treatment approach, and open surgical techniques for inguinal and femoral hernia repair are discussed elsewhere. (See "Classification, clinical features, and diagnosis of inguinal and femoral hernias in adults" and "Overview of treatment for inguinal and femoral hernia in adults" and "Open surgical repair of inguinal and femoral hernia in adults".)
A clear understanding of the anatomy of the groin and its anatomic approaches is important for successful laparoscopic hernia repair (picture 1A-C). The general anatomy of the abdominal wall and groin region and the course of the nerves to the abdominal wall are discussed elsewhere. (See "Open surgical repair of inguinal and femoral hernia in adults", section on 'Anatomic considerations' and "Open surgical repair of inguinal and femoral hernia in adults", section on 'Nerves of the groin region'.)
Laparoscopic repair approaches — When performing laparoscopic inguinal or femoral hernia repair, the hernia defect is approached from its posterior aspect and the repair involves placing mesh in the preperitoneal space (figure 1). The anatomic approach to the preperitoneal space depends upon the laparoscopic technique used for hernia repair. The two commonly used approaches to laparoscopic repair of inguinal and femoral hernias are the transabdominal preperitoneal hernia repair (TAPP) and the totally extraperitoneal hernia repair (TEP) approaches.
TEP repair — TEP is performed in the preperitoneal space and was developed to avoid the risks associated with entering the peritoneal cavity [3,4]. The surgeon develops a space between the peritoneum and the anterior abdominal wall so that the peritoneum is never violated. In experienced hands, this approach has the advantage of eliminating the risk of intraabdominal adhesion formation [4,5].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ANATOMIC CONSIDERATIONS
- Laparoscopic repair approaches
- - TEP repair
- - TAPP repair
- INDICATIONS FOR LAPAROSCOPIC REPAIR
- PREOPERATIVE EVALUATION AND PREPARATION
- Mesh for laparoscopic repair
- Patient positioning
- CHOICE OF PROCEDURE: TEP OR TAPP?
- TECHNIQUES FOR REPAIR
- Extraperitoneal exposure and dissection
- Transabdominal exposure and dissection
- Mesh placement and fixation
- TECHNIQUES FOR RECURRENT HERNIA REPAIR
- Re-do laparoscopic repairs
- POSTOPERATIVE CARE AND FOLLOW-UP
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS