Hellow guys, Welcome to my website, and you are watching Laparoscopic Transabdominal Preperitoneal (TAPP) Hernia Repair by Suturing: A Comprehensive Approach. and this vIdeo is uploaded by Dr. R. K. Mishra at 2024-12-27T03:02:48-08:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | Laparoscopic Transabdominal Preperitoneal (TAPP) Hernia Repair by Suturing: A Comprehensive Approach |
| Video Uploader | Video From Dr. R. K. Mishra |
| Upload Date | This Video Uploaded At 27-12-2024 11:02:48 |
| Video Discription | Laparoscopic Transabdominal Preperitoneal (TAPP) hernia repair has revolutionized the management of inguinal hernias, offering a minimally invasive alternative with excellent clinical outcomes. Among the techniques employed during TAPP, the suturing method for mesh fixation and peritoneal closure is gaining attention due to its cost-effectiveness, reduced foreign material implantation, and potential for better anatomical restoration. This article explores the critical steps, advantages, and technical nuances of performing TAPP hernia repair by suturing. Overview of TAPP Hernia Repair TAPP hernia repair involves gaining access to the preperitoneal space through a transabdominal approach, reducing the hernia sac, and placing a prosthetic mesh to reinforce the myopectineal orifice. The peritoneum is then closed to prevent adhesion formation between the mesh and intra-abdominal organs. Suturing, as opposed to using tackers or glues, offers several benefits: Reduced Foreign Material: Avoids the use of non-absorbable tackers, minimizing chronic pain and foreign body reaction. Cost-Efficiency: Eliminates the need for expensive fixation devices. Secure Fixation: Allows tailored and robust closure, especially in challenging anatomy. Key Steps in TAPP Hernia Repair by Suturing 1. Patient Positioning and Port Placement The patient is positioned in the Trendelenburg position to facilitate bowel displacement. A standard three-port technique is employed: A 10-mm supraumbilical port for the laparoscope. Two 5-mm working ports, typically in the midclavicular line on either side. 2. Creation of the Preperitoneal Space A peritoneal incision is made 4–5 cm above the hernia defect. Dissection is carried out to expose the hernia sac and critical structures such as the vas deferens, spermatic vessels, and Cooper’s ligament. The hernia sac is carefully reduced, ensuring no residual content remains. 3. Mesh Placement A pre-sized polypropylene or composite mesh (15 cm x 12 cm) is introduced into the preperitoneal space. The mesh is positioned to overlap the defect by at least 3 cm in all directions, ensuring adequate coverage. 4. Mesh Fixation by Suturing Suturing is performed using non-absorbable or slowly absorbable sutures (e.g., 2-0 or 3-0 barbed sutures or monofilament sutures). The mesh is secured at critical anatomical landmarks: Cooper’s ligament Transversalis fascia Rectus muscle or anterior abdominal wall Interrupted or continuous sutures are applied to prevent migration and ensure mesh stability. 5. Peritoneal Closure The peritoneal flap is closed using sutures to prevent mesh exposure and adhesion formation. A continuous barbed suture is particularly advantageous as it eliminates the need for knot tying and ensures tension-free closure. Technical Tips for Effective Suturing Ergonomic Needle Handling: Use a needle driver with an appropriate angle to facilitate needle manipulation in confined spaces. Maintain optimal wrist movements to achieve precise suture placement. Master intracorporeal or extracorporeal knotting for secure fixation. Consider barbed sutures for continuous suturing to simplify the process. Avoiding Critical Structures: Take care to avoid injury to vital structures such as the inferior epigastric vessels and nerves during suturing. Ensure adequate but not excessive tension to prevent ischemia of the peritoneum or mesh migration. Advantages of Suturing in TAPP Reduced Chronic Pain: Sutures avoid the rigid fixation points associated with tackers, reducing the incidence of chronic groin pain. Flexibility: Sutures can be placed precisely, adapting to the unique anatomy of each patient. Lower Costs: Sutures are more cost-effective than tackers or fibrin glues, making this technique attractive in resource-limited settings. Challenges and Solutions Learning Curve: Suturing laparoscopically requires advanced skills. Regular practice using simulators or dry labs can help. Time Consumption: Suturing may prolong operative time initially. However, proficiency reduces this disadvantage over time. Potential for Mesh Displacement: Proper training ensures that mesh fixation by suturing is as reliable as tackers or glues. Laparoscopic TAPP hernia repair by suturing is a valuable technique that combines cost-effectiveness, reduced foreign material use, and secure anatomical restoration. Although it requires advanced laparoscopic skills, the benefits of suturing outweigh its challenges, making it a preferred approach in appropriately selected cases. By adopting this method, surgeons can enhance patient outcomes, minimize complications, and promote the broader adoption of cost-efficient, minimally invasive surgical techniques. Contact us World Laparoscopy Hospital Cyber City, Gurugram NCR Delhi, India World Laparoscopy Training Institute Bld.No: 27, DHCC, Dubai, UAE World Laparoscopy Training Institute 5401 S Kirkman Rd Suite 340 Orlando, FL 32819, USA |
| Category | Education |
| Tags | Laparoscopic TAPP hernia repair | suturing in TAPP | mesh fixation | laparoscopic hernia repair | minimally invasive surgery | cost-effective hernia repair | peritoneal closure | suturing techniques | laparoscopic suturing | inguinal hernia repair | mesh placement | barbed sutures | intracorporeal suturing | preperitoneal space | advanced laparoscopic skills |
.png){kind=logo}
