Laparoscopic inguinal hernia surgery: TEP method, the ideal operation
What is a hernia – Symptoms
A hernia is a disorder that occurs in the abdominal wall at particularly vulnerable points and is a gradually occurring “rupture” of the muscle layers and fascia of that point, resulting in the outward projection of intra-abdominal viscera.
The particularly vulnerable points in the body are mainly the groin (mainly in men), the navel and the femoral ring (mainly in women), but also in any postoperative scar.
The symptoms are mainly pain, burning pain at the beginning of the hernia formation and followed by a sudden presence of a “soft” tumor at that point, which changes with movement, lying down, coughing, etc., or sometimes is reintroduced into the body (repositioned).
In women, inguinal hernias are much rarer than in men, and similarly present as either a straight or an oblique inguinal hernia, with the difference that in an oblique female hernia, the viscera follows the course of the round ligament of the uterus, with a subsequent course towards the vagina.
Often this hernia is “irreducible” (irreversible), that is, it is not possible to return the protruding peritoneal sac and its contents from the inguinal canal back to the abdomen, due to adhesions, increased muscle tension or even edema.
Mainly in these cases there is a very serious risk of hernia strangulation, a condition that can rapidly lead to permanent damage to intra-abdominal organs and even threaten the patient’s life.
If, for example, intestinal loops are constricted, the blood supply to the intestine is reduced or even suspended due to edema, a condition that leads in a short period of time, without the necessary immediate surgical treatment, to inflammation, peritonitis, obstruction of the intestinal tract and even necrosis of the intestine.
The femoral hernia is now dangerous for constriction in the area, due to special anatomy and for this reason it must be treated immediately.
The constriction is an “urgent surgical condition”, because it endangers the blood supply to the intestine, creates obstruction of the intestinal lumen (ileum) and requires immediate surgical intervention within a few hours, with the aim of “liberating” the intestine, rescuing it and then repairing the hernia.
The symptoms of a strangulated hernia are usually dramatic: severe pain in the groin with projection to the scrotum, abdomen or back, possible gas retention, vomiting, fever, drop in blood pressure, shock, etc.
The Treatment
Its treatment is exclusively surgical, since it is a matter of restoring the abdominal wall, while safely repositioning the intra-abdominal viscera in its place
Classical or laparoscopic surgery?
The classical method (open surgery) is performed with an incision in the groin, opening and transection of the muscle layers, opening the peritoneal sac, repositioning the viscera intra-abdominally, and suturing the mesh to the muscle and aponeurotic petals.
Over the last 20 years, the development of laparoscopy and laparoscopic surgery has contributed to the invention and creation of techniques for accessing the anatomical area of hernias, with the result that today, worldwide and in Greece, laparoscopic hernia repair with mesh placement has been established as an extremely safe procedure and ideal for its treatment.
The TEP (Total Extra Peritoneal Repair) method, which means Total Extraperitoneal Repair of the hernia, concerns the repair of the hernia outside the intra-abdominal space, under the muscle layers, at the exact point where the hernia occurs in the groin.
It is an excellent method, painless, atraumatic and bloodless, that can be applied to all types of inguinal hernias (inguinal hernia, femoral hernia), but also to bilateral inguinal hernias and to the recurrence of a hernia after open surgery.
The surgery is performed under general anesthesia, with the creation of a small incision of one centimeter below the navel and two others of 5 millimeters, without transection of muscles and walls.
An extremely large mesh is placed 10X15 or 12X17 cm, which covers all the easily pliable points of the inguinal area and is fixed with clips usually of absorbable material. Laparoscopic mesh application has many advantages, including the absence of incision and scar and the complications that accompany the open wound (inflammation, serous collection, suppuration, recurrence), the minimization of postoperative pain and immediate mobilization, the placement of a large mesh with absolute safety and parallel solution of all intra-abdominal adhesions laparoscopically that accompany especially postoperative hernias, the rapid recovery to return to work, excellent aesthetic results and minimization of recurrence (especially postoperative).
Excellent postoperative course
The postoperative course is excellent. The patient gets up in a few hours, eats immediately, leaves the clinic the next morning, and can return to work in a few 24 hours.
The treatment of other abdominal hernias such as umbilical hernia, epigastric hernia or postoperative abdominal hernia is also performed today with laparoscopic or robotic access, completely eliminating the creation of an incision in the anterior abdominal wall.
The indications for the application of laparoscopy in abdominal hernias are the same as for the placement of a mesh with open surgery.
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