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The first 25 slides, exactly as they appear. The full deck has 56 content slides.
General Surgery
Perspective on Hernias (B) Laparoscopic Inguinal Hernia Repair
Built from Maingot's Abdominal Operations
What’s inside
9 sections · 56 slides
Overview
- Topics covered
The laparoscopic operations
TAPP, TEP and IPOM — what each name means
- Laparoscopic inguinal hernia repair defined
- The two commonest laparoscopic repairs
- Intraperitoneal onlay mesh repair
- Three laparoscopic approaches
- Current standing of laparoscopic repair
Anatomy seen from inside
The groin as the laparoscope shows it
- The posterior view of the groin
- The myopectineal orifice
- Groin seen through the laparoscope
- The five nerves lateral to the deep ring
- Triangle of pain
- Triangle of doom
- External iliac artery running toward the groin
- Corona mortis
- Bony landmarks of the groin
- Danger zones around the deep inguinal ring
Choosing the approach
Open or laparoscopic, and for whom
- Open tension-free mesh repair as the standard
- Costs of the laparoscopic approach
- Open versus laparoscopic repair
- Hernias better served by the laparoscopic approach
- Relative contraindications
Points of technique
Where these authors would add emphasis
- Covering the pubic tubercle in TAPP repair
- Mobilising the inferior peritoneal flap
- Handling a large inguinoscrotal sac
- Slitting the mesh around the spermatic cord
- Mesh fixation
- Where not to place tacks
- Mesh in place after inguinal hernia repair
- Choosing between TEP and TAPP
- TAPP in the largest published series
Published outcomes
What the trials show, and what they do not
- Benefits shown in trials and meta-analyses
- Limits of the published outcome data
- Veterans Administration cooperative trial
- 10.1%
- Implications for patient and surgeon selection
- The learning curve
Complications
Rare, but some are catastrophic
- Overall morbidity after laparoscopic repair
- Four sources of complications
- Major vascular injury during access
- Sequence of a major vascular injury
- Managing a suspected major vascular injury
- Bowel and bladder injury
- Laparoscopic operating set-up
- Recurrence after laparoscopic repair
- Chronic pain after hernia repair
- Conservative treatment of groin pain
- When conservative measures fail
- Ladder of treatment for chronic groin pain
- Infertility and dysejaculation
Cost
Hospital bill versus total cost
- Hospital cost versus total cost
Conclusions
Where the balance falls
- Conclusions
- Indications with the widest agreement
- Summary
- References
- References (continued)
- Maingot's Abdominal Operations, 12th Edition