Transabdominal preperitoneal (TAPP) inguinal hernia repair: how we do it

Rivas, Jorge Farell; Molina, Ana Paula Ruiz-Funes; Carmona, Jorge Meza

doi:10.21037/ales-20-109

Cited by 6 publications

(4 citation statements)

References 3 publications

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“…This mesh is placed in the preperitoneal space that covers the miopectineal orifice (Fruchard). The peritoneum is then closed over the mesh leaving it between the preperitoneal tissue and the abdominal wall, where it becomes embedded by fibrous tissue [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes

Dumitrescu¹,

Serban²,

Costea³

et al. 2023

Cureus

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Inguinal hernia repairs are one of the most common procedures in general surgery. In addition to classical open surgery, laparoscopic techniques, such as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) hernia repair, have gained acceptance and are increasingly used for inguinal hernia repairs, and these three techniques are the only standards for inguinal hernia repairs. This study aimed to compare the results of inguinal hernia repairs in adult patients using the TAPP patch technique and Lichtenstein techniques regarding the level of pain perceived one day after surgery and the number of days of hospitalization. A two-year study was performed on 129 patients who underwent TAPP vs. 109 patients who underwent Liechtenstein hernia repair. Our results revealed statistical significance for both variables (Tpain(233) = -7.12, p< 0.001, d=2.92; Tdays of hospitalization(233) = -31.34, p< 0.001, d=4.01). TAPP is a safe method for inguinal hernia repairs, allowing quick recovery and less postoperative pain than the classical Liechtenstein technique.

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Section: Discussionmentioning

confidence: 99%

Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes

Dumitrescu¹,

Serban²,

Costea³

et al. 2023

Cureus

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“…TAPP was performed according to what has already been reported in literature for the laparoscopic approach [ 10 ]. Da Vinci® Si was used till September 2022, while for the remaining procedures, Xi system was used.…”

Section: Methodsmentioning

confidence: 99%

“…In summary, the procedure consisted of four main steps as described elsewhere [ 10 ]: the peritoneal flap creation, the completion of the critical view of the myopectineal orifice, the mesh application and the peritoneal flap closure.…”

Section: Methodsmentioning

confidence: 99%

Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon’s robotic experience

Solaini,

Cavaliere,

Rocco

et al. 2023

Hernia

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Purpose In this study, we aim to analyze the learning curve of each step of robotic transabdominal pre-peritoneal inguinal hernia repair (rTAPP) in two surgeons with varying degrees of expertise with the robotic platform but no experience with laparoscopic hernia repair. Methods Data on 124 rTAPP cases performed by two surgeons were retrospectively reviewed. Cumulative sum (CUSUM) analysis was applied to visualize the learning curve of rTAPP on operation time of each step of the procedure [the peritoneal flap creation (T1), the completion of the critical view of the myopectineal orifice (T2), the mesh application (T3) and the peritoneal flap closure (T4)]. Each intraoperative and postoperative outcome was compared according to surgeon’s experience with the robotic platform and learning phase. The robotic surgeon mentored the surgeon-in-training and was present during all surgeries in his learning period. Results The surgeon in training with the robotic platform showed a learning phase till the 20th procedure followed by a gradual improvement in performances. The expert surgeon showed a learning phase till the 35th procedure after which a constant decrease of operative time was recorded till the last procedure included. The operative times of each step of the procedures of both surgeons were significantly improved after the learning phase. In the late phase, the surgeon in training could achieve operative times in T2 and T3, which are similar to those of an experienced robotic surgeon with no experience with TAPP before the completion of the learning phase. Conclusions In conclusion, the learning phase of rTAPP surgery may vary between 20 and 35 cases, depending on the surgeon’s experience in robotic surgery.

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“…The peritoneum is incised on the lateral aspect and, the flap cut runs horizontally (lateral to medial) to reach the MUF, then, there is a change in direction of cut, so that it runs parallel to MUF (resembling a hockey stick). 2 Hence, the knowledge of variation in the anatomy of MUF is of immense clinical significance during laparoscopic exploration of the abdominal cavity, especially now as minimal access surgery (MAS) are being preferred over conventional open surgeries. Although, MAS has become one of the best options amongst doctors as well as patients due to its numerous advantages such as minimal access, minimal post-operative morbidity, shorter hospital stay and easy return to daily activities; however, efficacy of the surgery is directly and closely related to the surgeon's anatomical knowledge, skill, and experience.…”

Section: Knowledge Of Anatomical Variations With Respect To Persisten...mentioning

confidence: 99%

Patent umbilical artery in medial umbilical fold: Cadaveric study and clinical implications

Rani,

Kaushal,

Dada

et al. 2023

IJCAP

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Minimally invasive surgery has become one of the most accepted surgical options across the globe. In most laparoscopic surgeries, medial umbilical fold (MUF) containing the umbilical artery (UA) serves as an important landmark for creation of peritoneal flap. 50% of gynaecological laparoscopic injuries occur at the time of entry into the anterior abdominal wall, as it involves blind insertion of the trochar or veress needle in the peritoneal cavity. Any variation in the structures of the anterior abdominal wall may affect the placement location of the trocar, which is a crucial aspect to ease the surgeon’s ability to manoeuvre the abdominal cavity. The presence of cords and/or dense ligamentous structures in the anterior abdominal wall may complicate trocar insertion and restrict the probe movement during laparoscopic procedures. Hence, the aim of the present study was to classify and observe the variations in the MUF in the anterior abdominal wall.The cadavers in the study were formalin fixed through femoral artery perfusion method. Out of the 35 (23 males; 12 female) cadavers (70 MUF), studied, 34 cadavers (69 MUF) followed the pattern of the existing classification proposed by Tokar and Yucel, (2009). However, the right MUF of one male cadaver presented, patent umbilical artery (PUA) associated with a long mesentery. Based on safe presentations for laparoscopic exploration, MUF was given grades. Grades 0 and 1 were categorised as safe as compared to grade 2 and the novel variant observed, based on the morphology of MUF. No significant difference was noted in the occurrence of safe presentations of MUF amongst males and females.MUF with a patent vessel and a mesentery may cause technical difficulties to the surgeon by decreasing the laparoscopic port work space and obscuring the view of lateral pelvic wall during surgeries. Furthermore, persistent UA can compress the ureter and vas deferens resulting in myriad of symptoms ranging from unexplainable flank pain, hydronephrosis to male infertility. Awareness of such variants is of relevance to urologists in determining the cause of these unexplained symptoms and to surgeons in determining the site of safe trocar insertion. The findings also, highlight the fact that anterior abdominal wall anatomy is not mirror image on both the sides.

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Transabdominal preperitoneal (TAPP) inguinal hernia repair: how we do it

Cited by 6 publications

References 3 publications

Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes

Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes

Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon’s robotic experience

Patent umbilical artery in medial umbilical fold: Cadaveric study and clinical implications

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