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Laparoscopic Digestive > Treatment of inguinal hernia
TREATMENT OF INGUINAL HERNIA

The inguinal hernia consists out of a bulging of an intra-abdominal organ through the lower abdominal wall (in the pubic region). A bulging is seen in the groin. Either deductible under light pressure or in decubitus or non-deductible and painful (stranglutated hernia)

One can find three types of inguinal hernias:

- Direct: directly through the abdominal muscular wall.

- Indirect: in men following the spermatic cord to the scrotum, in women following the round ligament to the labia.

- Crural: following the femoral vessels.

A direct hernia can co-exist with a indirect hernia: called a combined hernia

The intervention consists out of placing a non-resorbable prosthetic mesh (see picture) over the three orifices of the hernia. In this mesh scar tissue will be formed to make a strong addition to the muscular wall.

prothèse non résorbable

                                                   (Click on picture to enlarge)  

The laparoscopy allows two ways of approach:

  • By a trans-peritoneal route – TAPP  with opening en closing the peritoneum

  • By an extra-peritoneal route - TEPP (just boarding the peritoneum) without entering abdominal cavity, the procedure is performed between the muscular wall and peritoneum.

Either technique has excellent results: 1% reoccurs over a period of 10 years

The intervention necessitates 3 trocar holes. Discharge of the patient, can be form 24 to 48 hours after surgery

                                                                             TAPP

voie trans-péritonéale hernie inguinale bilatérale: voie trans-péritonéale

  . voie trans-péritonéalehernie inguinale bilatérale; voie trans-péritonéale

 hernie inguinale "en pantalon"hernie inguinale gauche avec son contenu graisseux

 voie trans-péritonéale: réduction du sac herniairevoie trans-péritonéale: prothèse

 

 

                                                                           TEPP

voie extra-péritonéalehernie inguinale gauche "en pantalon": voie extra-péritonéale

voie extra-péritonéale

                              (Click on pictures to enlarge)



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