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Approaches to Recurrences After TAPP Laparoscopic Hernioplasty,
Authors: Motyčka Vladimír | Sákra Lukáš | Havlíček Karel | Šiller Jiří | Daněk Tomáš
Year: 2005
Type of publication: článek v odborném periodiku
Name of source: Journal of the Society of Laparoendoscopic Surgeons
Publisher name: Society of Laparoendoscopic Surgeons
Place: Miami
Page from-to: 15
Titles:
Language Name Abstract Keywords
cze Přístup k problematice recidiv po TAAP plastice tříselné kýly Článek se zabývá laparoskopickým řešením recidivující tříselné kýly po laparoskopické TAPP plastice a úskalími této metody. tříselná kýla;laparoskopická plastika;recidiva kýly;TAPP;dual-mesh
eng Approaches to Recurrences After TAPP Laparoscopic Hernioplasty, At the Surgical Department of General Hospital, Pardubice, we operate about 300 patients for groin hernia every year. In about 60% of inguinal hernia repairs we use a laparoscopic approach, preferably TAPP. In spite of some disadvantages (higher cost, steep learning curve, possibility of more serious complications and necessity for general anesthesia), the laparoscopic approach presents more advantages. Besides the well-known positives of the laparoscopic approach, this technique is also connected with a lower recurrence rate. Although some trials demonstrated the same or even lower recurrence rate for the open mesh repair of groin hernia, in our study it is the laparoscopic technique that brings a lower hernia recurrence rate. In rare cases of hernia recurrence after TAPP laparoscopic hernioplasty (0.96 % in our study), we can repair the condition by means of an open procedure (tension-free repairs ? Lichtenstein patch repair, plug and patch, or the Prolene Hernia System) or of the laparoscopic approach. There are advantages and disadvantages to each approach. We prefer the laparoscopic approach. This presentation deals with the difficulties of the laparoscopic hernioplasty of a recurrence after a TAPP procedure. The laparoscopic repair of a recurrence is rather difficult due to the firm adhesions in the hernia area to an original mesh. We recommend (after incision of the peritoneum) releasing a hernia sac from the former patch. Then we put a non-adhesive mesh into the preperitoneal space. The peritoneum in the groin area (in an incision and suture line) after a TAPP hernioplasty is usually changed into a scar tissue. In such cases a peritoneum closure above the mesh could be difficult and sometimes even impossible; therefore, a non-adhesive dual-mesh is suitable and will not cause any adhesions to intraperitoneal organs in the future. Our experience with this procedure has been very good and complications have been rare. Groin hernia;Laparoscopic Inguinal Hernioplasty;Recurrent Hernia;TAPP;Dual-mesh

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