Laparoscopic hernia surgery
I have been performing laparoscopic repair of incisional and inguinal hernias for more than 15 yeras
-Inguinal hernias: My preferred approach is the TEP (Totally Extra Peritoneal), this does not breach the peritoneum and therefore does not invade the peritoneal cavity. This is performed via a 10mm sub umbilical approach helped by other 2 5mm ports or sometimes one 3mm and one 5mm. The virtual preperitoneal space is opened using an special balloon and once the hernia is reduced a 10 by 15 cm mesh is placed and secured with absorbable tacks. Some times due to previous abdominal surgery and infraumbilical scars this approach is not possible, then is when I use the TAPP (Trans Abdominal Pre Peritoneal)
The laparoscopic approach does not only allow a quicker recovery but also prevents from nerve injury, not uncommon in open surgery, leading to sometimes chronic and invalidating pain.
laparoscopic TEP hernia repair is not an easy procedure and therefore should be done by surgeons with well developed laparoscopic skills
-Incisional hernias: I have also been doing lap incisional hernias fore more than 15 years. The repair is carried out through 3 ports, one 10mm and two 5mm. Once entered the abdominal cavity and identified the defect from inside an special mesh is applied and fixed with two crowns of absorbable tackers. despite of being minimally invasive, it is a painful procedure that requires intensive analgesia for 2 to 3 days
The best outcome will be those with defects no bigger than 5-6 cm.