Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair

The inguinal hernia repair is one of the most frequent surgical procedures: in the world, even year, at least 20.000.000 inguinal hernia repair procedures are performed. Although the laparoscopic approach is widely recognized as a valid treatment for many diseases and some laparoscopic surgical procedures have become gold standard techniques (e. g. cholecystectomy, appendectomy, gastro-esophageal junction surgery), the minimally invasive approach for groin hernia treatment is still very controversial today, but in the last few years, it tends to become the standard practice for 1 day surgery. We present here the technique of laparoscopic Transabdominal Preperitoneal approach (TAPP). The surgical technique is described step-by-step, including surgical details and the new concept of “inverted Y” to achieve the “critical view of safety” for laparoscopic inguinal hernia repair.

ANALYSIS OF IMMEDIATE AND LONG-TERM RESULTS OF SUBLAY AND TAPP TECHNIQUES IN THE TREATMENT OF VENTRAL HERNIAS

The accumulated clinical experience has proven that the “sublay” technique allows to achieve greater functional activity of the anterior abdominal wall and is the method of choice in the treatment of ventral hernia. The use of self-adhesive nets during laparoscopic transabdominal preperitoneal plasty (TAPP- Transabdominal Preperitoneal Plastic) in the treatment of small and medium ventral hernia is safe and effective, with low values of postoperative pain syndrome and rapid functional recovery after surgery, without increasing the recurrence in the short term. The aim – was to analyze the immediate and long-term results of “sublay” and TAPP techniques in the treatment of ventral hernias of lower and median localization. The author noted that the search for technical methods aimed to reduce the intra-abdominal pressure in this hernioplasty technique was relevant and practically significant. Material and Methods. The work was performed on the basis of the surgical department of the State Institution “Specialized Multi-Purpose Hospital №1 of Ministry of Health of Ukraine”, Department of General Surgery of the State Institution “Dnipro State Medical University of Ministry of Health of Ukraine”. Results. Comparison of immediate and long-term results of peritoneal-prosthetic-aponeurosis thickness studies showed a statistically significant difference (p < 0.001) using different techniques. When analyzing the separated results, reliable differences (p <0.001) depending on the gender of patients were recorded. Thus, in males, when using the “sublay” technique the peritoneal-prosthetic-aponeurosis thickness was greater by 1.15 mm (by 42.43 %) in comparison with the Tapptechnique, and in females, by 1.16 mm (by 42.09 %), respectively. Conclusions. The analysis of the immediate and long-term results of the “sublay” and TAPP techniques in the treatment of ventral hernias of lower and median localization showed that the “sublay” technique was characterized by traumatic surgical intervention, shift of the prosthesis to one side, as a consequence of its deformation. When using this technique, peritoneum-prosthetic-aponeurosis thickness values were significantly higher – by 13.16 % and 42.40 % in the early and distant postoperative periods, respectively. Also, when using the Tapp technique in the distant period the thickness was significantly reduced (p <0,0001) by 49,47 % in comparison with the immediate results.