Background:
-The laparoscopic cure of an inguinal hernia can be carried out in extra peritoneal space only (TEP), or via by opening the peritoneal leaflet through the peritoneal cavity or trans-abdominoperineal approach (TAPP).
-The laparoscopic approach is not indicated for patients with a medical condition (e.g. chronic obstructive pulmonary disease, stage Gold 4). For these patients, this intervention can be performed under spinal anesthesia or even under local anesthesia. Laparoscopic approach can also performed in emergency conditions for incarcerated or strangled inguinal hernias. This intervention should be supplemented by exploratory laparoscopy to rule out the presence of intestinal ischemia / necrosis. An indication may also be obsolete for patients with a history of orthopedics, prostate surgery or on anticoagulants. If the intervention is hemorrhagic, an aspirating drain can be left in place at the level of the inguinal canal.
– The patient can present a sensation of mass, pain during physical exertion or sporting activity during a prolonged orthostatic position. This mass can increase in volume during cough of physical effort. Inguinal hernia can be interstitial hernia (in the canal) / as a point of hernia (exceeding the superficial opening) / a funicular hernia (along the cord) / an inguino-scrotal hernia (unfolding the scrotum).
– In case of doubt at palpation, a control abdominal ultrasound is requested.
Postoperative attitude:
– After a laparoscopic hernia treatment, the postoperative attitude remains the same regardless of whether it is the treatment of a unilateral or bilateral inguinal hernia.
• Day0 – the evening of the operation the patient could have a TBB diet if there are no symptoms such as nausea or vomiting following the anesthesiologist, otherwise he can drink water for his comfort and the discharge can be authorized in the evening.
• Day1- The patient is mobilized during the morning, and the discharge is authorized.
Complications:
• Acute urine retention – in case of extensive bladder dissection, direct hernia with a bladder horn as content or significant hemostasis on the bladder wall
• Bleeding – clinically manifested by the appearance of a mass of fluid consistency in the scrotal area and a blue coloration of the integuments opposite the inguinal region concerned
• Acute testicular edema and pain during movement – probably related to improper positioning of the mesh.
Sorin Cimpean - General Surgeon 