Inguinal hernia surgery, one of the commonest and oldest operations practiced throughout history, did not escape revolutionary advances witnessed in medicine in the last few decades

1. INDRODUCTION
Inguinal hernia surgery, one of the commonest and oldest
operations practiced throughout history, did not escape revolutionary
advances witnessed in medicine in the last few decades
(Abrahamson, 1997)
The term tension free hernioplasty was first used by
Liechtenstein and associates in 1986. They accepted that the
transversalis fascia was the only support of the floor of the inguinal
canal. Liechtenstein popularized the concept of avoiding closure of a
hernia defect under tension with sutures. Liechtenstein and associates
described a surgical technique that consisted of a sutured on - lay
mesh patch as the primary hernia repair. This repair had significance
that the mesh prosthesis was not utilized to buttress or supports a
primary sutured herniorrhaphy but it was the actual repair. No
attempts were made to approximate weakened tissue with sutures so
they avoided any distortion of normal anatomy and suture - line
tension (Liechtenstein et al., 1997).
Laparoscopic hernia repair is a case in point. Clinical outcomes
testing in the form of prospective clinical trials has shown the
procedure to be safe and effective and to offer some advantages over
open repair, namely, less pain and a more rapid recovery period. On
the other hand, this surgery has been shown to be difficult to learn
and more costly (McIntosh, 2005).
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Introduction

2. The techniques of laparoscopic hernioplasty include the
following techniques:
1. A Transabdominal preperitoneal (TAPP)
2. A Totally extra peritoneal (TEP) approach
3. Intraperitoneal onlay mesh (IPOM) technique
The three techniques are based on the principles of using mesh
prosthesis to cover the defect of the abdominal wall from inside
(Hem and vroonhoven, 1996)
Transabdominal preperitoneal is the most commonly
performed laparoscopic procedure (freedman and Phillips 2002), and
this technique is performed most frequently (60%) followed by the
(TEP) approach (18%) and the (IPOM) repair (11 %). Thus, there
appears to be a preference for mesh placement in the preoperational
space, in accordance with the idea of Stoppa (Liem and van
vroonhoven, 1996).
Laparoscopic herniorrhaphy has a multiple disadvantages that
include: the need for general anesthesia, time consuming specially in
the early learning curve of the surgeons, costly and has a higher
complication rate which may be serious leading to the need of the
second abdominal operation (Fitzgibbons and FiIlip, 2002).
Till 2002, the role of laparoscopic herniorrhaphy remains
controversial, and the open hernia repair takes the major role in
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Introduction

3. hernia repair. However, further follow up is needed to evaluate the
late effects of this introduced laparoscopic surgical technique
(Fazzio, 2002).
A laparoscopic method of performing a tension – free repair
has subsequently been reported to result in low recurrence rates and
to be associated with substantially less pain in the immediate
postoperative period and earlier in the immediate postoperative
period and earlier return to normal activities than the open-repair
technique (McCormack et al., 2003).
Laparoscopic inguinal herniorrphy was introduced in the late
1980 & early 1990s at time when many surgeons felt that most
commonly performed abdominal procedure would eventually be
adapted for laparoscopic method (Robert et al., 2005).
Laparoscopic inguinal herniorrphy was described by Ger in
1982, who pointed out its potential advantages such as less
postoperative discomfort or pain, reduced recovery time allowing
earlier return to full activity, easier repair of a recurrent hernia
because the repair is performed in tissue that has not been previously
dissected, the ability to treat bilateral hernias, the performance of a
simultaneous diagnostic laparoscopy, the highest possible ligation of
the hernia sac, and improved cosmesis (Ger, 1982). Totally
Extraperitoneal (TEP) procedure is modeled after the Cheatle-Henry
preperitoneal hernioplasties to adress some of the major criticism of
the laparoscopic Trans abdominal preperitoneal (TAPP) procedure,
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Introduction

4. namely the need to enter the peritoneal cavity and the attendant risk
of injury to an interabdominal organ, intestinal obstruction secondary
to adhesive complications, or trocar site herniation (Robert et al,
2005).
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Introduction