Laparoscopy, with a pre-peritoneal (TEP) or trans-peritoneal (TAPP) approach, represents a valid therapeutic option also in case of inguinal hernia . Our expert in General Surgery and Colonproctology in Turin , Dr. Stefano Enrico, explains what the TAPP technique consists of
What is the TAPP technique?
The TAPP techniqueallows, through small access holes to the abdominal cavity (generally three) of 5-10 mm, to intervene on the internal part of the hernial door by positioning a particular type of mesh (mesh) capable of correcting and closing the wall defect. Once the hernial contents have been reduced in the abdomen, it will be necessary to create a pocket in the peritoneum in which to place the aforementioned net with biological glue. This type of substance ensures correct fixation without the risk of causing vascular or nerve damage in the patient, thus reducing the percentage of postoperative complications. In addition, there are special nets equipped with pedicels similar to Velcro, which allow correct fixation without the need for points or glues. Afterwards, the positioned network will be covered by the peritoneal flap,adhesions with the loops of the intestine.
What are the characteristics of the traditional technique?
The traditional technique, as far as it can resort to methods capable of limiting the sutures on the muscles and the bands (tension free) to reduce the pain following the surgery, still requires the execution of an incision of several centimeters in the inguinal area, as well as the separation of muscles and fascias until the defect of the wall to be corrected is identified.
A “plug” and a non-absorbable net are then placed, which close the hernial door by integrating into the scar tissue. Damage to the ileoinguinal nerve is quite common with traditional surgery and this can alter the sensitivity of this area or cause postoperative neuralgia for several months.
Following the operation, it will be possible to resume moderate physical activity after two weeks, but to perform sports or heavier work it is recommended to wait at least a month. The advantages of traditional surgery are represented by the lower cost of the intervention, the low general surgical impact and the possibility of being performed under local anesthesia with DH.
What are the pros and cons of laparoscopy instead?
The laparoscopic procedure necessarily requires a general anesthesia with an overnight stay following the operation. On a technical level, the method is more complicated and must be performed by experienced surgeons to reduce risks. On the other hand, the advantages of the laparoscopic approach are:
- Faster and less painful recovery;
- Ability to resume physical activity in a few days.
Furthermore, it is a technique particularly indicated in the following cases:
- Young patients with strong tissues and intense physical activity;
- Patients who practice sports at professional or amateur level, who need a quick recovery (it is possible to place a net with a higher seal against physical loads);
- Bilateral hernia (a single intervention to treat both defects);
In any case, it is good to underline that each patient requires personalized treatment. The specialist will then decide, depending on the patient’s needs and status, which of these techniques is the most appropriate.