Challenges to the 10 Golden Rules for a Safe Minimally Invasive Surgery (Mis) Inguinal Hernia Repair: Can We Improve?

Abstract

Background: Since publication of our paper “Ten Golden Rules for a Safe MIS Inguinal Hernia Repair” we have received many questions. As the authors, we feel it is important to address these topics as a follow-up to our paper. Aim: To discuss in more details the main points of controversy, review the rules and update de recommendations. Method: The questions and discussions came mainly over five rules, numbered 3, 5, 6, 7, 10. We analyzed all the comments about recommendations and update some technical principles. Results: Rule 3 - Removing normal fat plugs from the obturator canal is unnecessary and therefore is not recommended; Rule 5 - transection of the uterine round ligament (1 cm proximal to the deep ring) facilitates adequate dissection. When performed in this way it does not appear to be associated with complications; Rule 6 - transection of huge sacs are safer than over-dissection of the cord structures. Whether dissecting completely the sac or abandon the distal part it results in less postoperative seromas is an ongoing debate; Rule 7 - any retroperitoneal structure traversing the internal ring is or play a role like a hernia. Failing to identify and remove the lipoma will ultimately result in the patient experiencing a recurrence; Rule 10 - in TAPP peritoneum should preferably be closed with suture than tackes. Conclusion: 10 Golden Rules emphasize the most important surgical tips and technical steps that allow the safe performance of MIS repairs of inguinal hernias, regardless the technique.

Current status and progress of laparoscopic inguinal hernia repair: A review

“…9: Fixation of the patch is unnecessary, especially in TEP repair. 10: Deflation should be performed under direct visualization [33,34] (Fig. 4).…”

Titanium Clips for Closure of the Peritoneal Flap During Laparoscopic Inguinal Hernia Repair

“…The transabdominal preperitoneal (TAPP) technique is one of the most performed procedures in laparoscopic inguinal hernia repair 10 . It involves the opening of the peritoneum to access the preperitoneal space for an adequate dissection of the Fruchaud myopectineal orifice and a correct positioning of the mesh 3 .…”

Liechtenstein Versus Correção De Hérnia Laparoscópica Transabdominal Pré-Peritoneal (Tapp): Um Estudo Comparativo Prospectivo Com Foco Nos Resultados Pós-Operatórios Em Uma Unidade De Cirurgia Geral

“…Esses aspectos agregam responsabilidade devido existência de uma alternativa validada há décadas. Por fim, questiona-se o perfil do paciente inicial candidato à abordagem laparoscópica, além de considerar a experiência da equipe cirúrgica 6 .…”

“…These aspects add responsibility due to the existence of an alternative that has been validated for decades. Finally, the profile of the initial patient candidate for the laparoscopic approach is questioned, in addition to considering the experience of the surgical team 6 .…”