Laparoscopic Groin Hernia Repair

Laparoscopic repair involves placement of a preperitoneal prosthetic biomaterial. The repair follows the same principles as the open preperitoneal (Stoppa) repair. After reducing the

Figure 14.13. Mesh in the preperitoneal space overlying the myopectineal orifice.

hernia sac a large piece of mesh is placed in the preperitoneal space covering all potential hernia sites in the inguinal region (Fig. 14.13). The mesh becomes sandwiched between the preperitoneal tissues and the abdominal wall and, provided it is large enough, is held there by intra-abdominal pressure until such time as it becomes incorporated by fibrous tissue.

The choice between the TAPP and the TEP repair is merely a matter of personal preference. There is no clinical difference between the conversions to open, the complications seen, or the recurrence rates between these two operations in experienced hands. The TEP may be the more expeditious and less costly procedure based upon operating room expenses.

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