Laparoscopic or minimally invasive Inguinal Hernia repair
The balloon and the camera.
The keyhole operation has evolved over the last decade. It is the latest edition of the many surgical repairs that have been used over the last century. (If interested see the History page).
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The keyhole operation was introduced at the same time as the open Lichtenstein mesh repair was becoming popular.
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It has 2 approaches. The first enters the abdomen and has the added risk of intra abdominal injury. (this is the Trans Abdominal Pre Peritoneal or TAPP operation). The second keeps outside the abdominal cavity ( the Totally Extra Pre Peritoneal or TEPP operation).
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The TEPP operation was difficult to do but has evolved and become a very good operation.
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For surgeons experienced in the older operations, the TEPP procedure has an anatomical and mechanical foundation that is the gold standard in hernia repair. The anatomy can be beautifully defined, both the indirect, direct and the femoral hernia space are repaired and Laplace makes the long term result more certain.
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It is ideal for men with a generalised weaknes of the area or who both direct and indirect hernia. It is also the ideal operation for bilateral hernia as both sides can be repaired through the ports.
Why not use in everyone ?
The reason is that not all hernia need this approach. Mesh is used routinely in keyhole surgery and can produce problems. The TEPP & TAPP operation reinforce the entire inguinal area and this is not always needed. For example small early inguinal hernia in men can be beautifully treated by an anatomical open repair, closing only the small defect with a few sutures. Mesh is not needed.
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This closure of the sac is all that is needed to repair most childhood inguinal hernia.
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