What is the surgical technique for inguinal (Inguinal) hernia repair using the TAPP (Transabdominal Preperitoneal) method?

From the Guidelines

The TAPP inguinal hernia repair surgical technique is a recommended approach due to its minimally invasive nature and comparable outcomes to the standard open technique, as suggested by data from laparoscopic approaches to inguinal hernia repairs 1. The procedure involves making three small incisions: one at the umbilicus for the laparoscope and two working ports placed laterally at the level of the umbilicus.

• Key steps in the TAPP technique include:
  • Establishing pneumoperitoneum and inspecting the abdominal cavity to identify the hernia defect
  • Creating a peritoneal incision and dissecting the preperitoneal space to expose the myopectineal orifice
  • Identifying and preserving key structures such as the inferior epigastric vessels, Cooper's ligament, iliopubic tract, and spermatic cord
  • Reducing the hernia sac and placing a synthetic mesh to cover all potential hernia sites
  • Securing the mesh with tacks, staples, or sutures while avoiding sensitive areas
• The TAPP approach offers several advantages, including:
  • Visualization of both sides for bilateral hernias
  • Reduced post-operative pain
  • Faster recovery
  • Lower recurrence rates compared to open repairs However, it requires greater technical expertise and longer operating times, as noted in the assessment and management of inguinal hernia in infants 1.

From the Research

TAPP Inguinal Hernia Repair Surgical Technique

• The TAPP (transabdominal preperitoneal) repair is a laparoscopic technique used for inguinal hernia repair 2, 3, 4, 5.
• The TAPP technique involves making small incisions in the abdomen to insert a laparoscope and surgical instruments, and then repairing the hernia from inside the abdominal cavity 2, 3.
• The TAPP technique has been compared to other laparoscopic techniques, such as TEP (totally extraperitoneal) repair, in several studies 2, 3, 4.
• The studies have shown that TAPP and TEP have similar outcomes in terms of recurrence rates, postoperative pain, and complications 2, 3, 4.
• However, some studies have reported that TAPP may be associated with a higher risk of seroma formation and visceral injuries compared to TEP 3, 5.
• The choice of technique may depend on the surgeon's skills, education, and experience, as well as the individual patient's needs and preferences 2, 3.

Comparison with Other Techniques

• The TAPP technique has also been compared to open repair techniques, such as the Shouldice technique, in several studies 5.
• The studies have shown that TAPP may have advantages over open repair in terms of reduced postoperative pain and faster recovery times 5.
• However, the studies have also reported that TAPP may be associated with a higher risk of complications, such as seroma formation and visceral injuries, compared to open repair 5.

Outcomes and Complications

• The outcomes and complications of TAPP repair have been reported in several studies 2, 3, 4, 5.
• The studies have reported that the recurrence rate for TAPP repair is generally low, ranging from 0-5% 2, 3, 4.
• The studies have also reported that the most common complications of TAPP repair are seroma formation, visceral injuries, and postoperative pain 2, 3, 4, 5.