A brief presentation on laparoscopic mesh repair of inguinal hernia esp for undergraduate students.

1. Dr. Loveleen Garg,
PG Resident, Deptt. of Surgery

2.  Intraperitoneal onlay mesh technique: A mesh is
placed under the hernia defect intra-abdominally
to circumvent a groin dissection.
 Totally extraperitoneal technique: The peritoneal
cavity is not entered, and a mesh is used to cover
the hernia from outside the preperitoneal space.
 Transabdominal preperitoneal technique: A
laparoscopic repair procedure wherein the
surgeon enters the peritoneal cavity, incises the
peritoneum, enters the preperitoneal space, and
places the mesh over the hernia; the peritoneum
is then sutured and tacked closed.

5. Intraoperative view by TEP
Operation.
1. Genital ramus of genitofemoral
nerve.
2. Preperitoneal lipoma and
spermatic cord.

12.  TEP
 PRIMARY HERNIA
(UNILATERAL OR
BILATERAL)
 RECURRENT HERNIA
 PRIOR ABDOMINAL
SURGICAL
HOISTORY, EVEN
INVOLVING LOWER
MIDLINE.
 TAPP
 INCARCERATIONS
OR
STRANGULATION
 SCROTAL HERNIAS
 INGUINODYNIA
 RECURRENCE AFTER
TAPP OR TEPP.

13. Advantages Disadvantages
•Quicker recovery •Needs surgeon highly
experienced
•Less pain during first
days
Longer operating time
•Fewer postoperative
complications
such as infections,
bleeding and seromas
Increased recurrence of
primary hernias if
surgeon not experienced
enough
•Less risk of chronic pain

14. Meshes
◦ Permanent mesh
◦ Commercial mesh
◦ Mosquito-net mesh

15.  Seven important properties of mesh are:
1. Withstands physiologic stresses over time
2. Conforms to the abdominal wall
3. Mimics normal tissue healing
4. Resists the formation of bowel adhesions and
erosions into visceral structures
5. Does not induce allergic reaction or foreign body
reactions
6. Resists infection
7. Is noncarcinogenic

16.  Surgical mesh products are typically made
from polypropylene or polyester.
 Other available materials include:
◦ Polytetrafluoroethylene
◦ Polyglactin
◦ Polyglycolic acid
◦ Polyamide

17. Complications are frequent (>10%).
◦ Foreign-body sensation
◦ Chronic pain
◦ Ejaculation disorders
◦ Mesh migration
◦ Mesh folding (meshoma)
◦ Infection
◦ Adhesion formation
◦ Erosion into intraperitoneal organs
 In the long term, polypropylene meshes face
degradation due to heat effects.
 obstructive azoospermia

18. Biomeshes
◦ they can be used for repair in infected environment,
an incarcerated hernia
◦ reduce the risk of inguinodynia