Totally preperitoneal laparoscopic inguinal herniorrhaphy using balloon distention

Area of Science:

• Minimally Invasive Surgery
• Surgical Innovation
• Hernia Repair Techniques

Background:

• Previous experience with over 200 transabdominal preperitoneal (TAPP) laparoscopic hernia repairs with excellent outcomes.
• Transition to a totally preperitoneal (TPP) repair facilitated by the development of a new balloon trocar for preperitoneal space creation.

Purpose of the Study:

• To evaluate the early outcomes and feasibility of the totally preperitoneal (TPP) laparoscopic hernia repair technique.
• To compare the TPP approach with the established TAPP procedure in terms of safety and efficacy.

Main Methods:

• The TPP procedure involves detailed anatomical delineation of Cooper's ligament, spermatic cord, and transversus abdominis arch.
• Mesh fixation to Cooper's ligament and arch ensures an anatomic, tension-free repair, similar to the TAPP technique.
• Utilized a novel balloon trocar to facilitate preperitoneal space creation.

Main Results:

• Early experience includes 60 hernia repairs in 50 patients, encompassing direct, indirect, and femoral hernias, including recurrent cases.
• The operation demonstrated no reported morbidity, with an average duration of approximately 1 hour.
• Patients experienced minimal postoperative discomfort and a rapid return to regular activities within 2 to 3 days.

Conclusions:

• The totally preperitoneal (TPP) technique is considered a preferred method for laparoscopic hernia repair.
• Avoidance of peritoneal incision in TPP eliminates the risks of intra-abdominal adhesions associated with the TAPP procedure.
• TPP offers a safe and effective alternative with favorable patient recovery.