Preperitoneal drainage for 23 h after laparoscopic TEP hernioplasty for inguinal hernia can effectively decrease seroma formation in the early postoperative period, and potentially improving postoperative pain. The benefit is short-term and no significant difference was demonstrated after 1-month post operations. This tradition technique applied to novel operative repair of inguinal hernia is safe and feasible with no significant morbidity demonstrated. Preperitoneal drainage after TEP can be considered as an option to improve patient satisfactions and recovery in selected patient group for maximal benefit, especially for those with prolonged operation which may associate with higher chance of seroma formation.
Laparoscopic inguinal hernia repair is performed more and more nowadays. The anatomy of these procedures is totally different from traditional open procedures because they are performed from different direction and in different space. The important anatomy essentials for laparoscopic inguinal hernia repair will be discussed in this article. Laparoscopic inguinal hernia repair is performed more and more nowadays because of its mini-invasive nature and demonstrated good results. Laparoscopic procedures are especially suitable for recurrent and bilateral inguinal hernia (1,2). The major procedures include intraperitoneal onlay mesh (IPOM) repair, transabdominal preperitoneal (TAPP) repair and total extraperitoneal (TEP) repair. The anatomy of these procedures is totally different from traditional open procedures because they are performed from different direction. Laparoscopic operations for inguinal hernia are carried out intraperitoneally or in preperitoneal space. Surgeons must understand important anatomic acknowledge of the operation area under laparoscopic views before they begin to perform these procedures, otherwise it will be very risky to cause complications such as bleeding, nerve damage, insufficient repair and recurrence. The main anatomic points are discussed as followed.
Keywords
Myopectineal orificeThis anatomic region was originally coined by Dr. Fruchaud, a French researcher, in 1956. Direct inguinal hernias, oblique inguinal hernias and femoral hernias are all caused by weakness of the abdominal transverse fascia in myopectineal orifice (Figure 1). The inguinal ligament divides the myopectineal orifice into two regions: the suprainguinal region and the subinguinal region. The spermatic cord or the round ligament of the uterus runs through the suprainguinal region, while the femoral nerve, the femoral artery, the femoral vein and the femoral canal run through the subinguinal region. The deep layer of the myopectineal orifice is closed off by the abdominal transverse fascia, which surrounds the spermatic cord, and the femoral sheath, which passes through the myopectineal orifice. A single-side repair of the myopectineal orifice can simultaneously and completely repair the site of anatomical weakness for inguinal, direct and femoral hernias. This
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