IN THE NAME OF ALLAH
THE MOST GRACEFUL THE MOST MERCIFUL
1. Laparoscope 300
2. Three – four Trocars (10-12 m.m.) + reducers
5. Diathermy needle
6. Suction tube
8. Endo-Clip clips
9. Marlex, polypropylene mesh or surgipro (different sizes)
10. Laparoscopic needles and needle holders
ANATOMY FROM INSIDE
Pre-peritoneal Real View
Types of Laparoscopic Repair
1. On-Lay mesh patch
a) pre-peritoneal mesh
b) plug and mesh
c) Cigarettes and mesh
3. Extra-peritoneal approach
ON-LAY MESH PATCH
Intra – peritoneal
Weight of viscera to fix it
Complications (adhesions, obstruction and
Less testicular pain and swelling
Not recommended by many authors
Mesh only mesh and plug mesh and
MESH AND PLUG
MESH AND CIGARRETTES
(Video – presentation)
Advantages of Laparoscopic Hernia Repair
1. Anatomy is clear.
2. Suitable for bilateral and recurrent hernias.
3. Quick convalescence (resume working after 1-7
4. Less pain and scrotal swelling post-operatively.
5. Inguinal canal is not opened (less risk of nerves
and cord injuries)
1. A little more expensive than anterior approach.
2. Higher recurrence rate (initial studies) than anterior
approach Viz: Bassini’s, McVay or Litchenstien’s repair.
3. Requires G.A.
4. Takes a little longer operating time ( 2 – 2 ½ hours)
5. Needs experts.
Training requirements for
Laparoscopic Hernia repair
1. Attending basic courses in Laparoscopic surgery.
2. Training course in Hernia repair.
3. Surgeon should be familiar with the instruments.
4. Should know how to operate with both hands.
5. Learn how to suture laparoscopically.
6. Learning the anatomy of the region (very important).
7. Observing experts, assisting them and operates later
(avoid long recoveries because of
(avoid dissecting scarred tissues, so less
chance of cord and nerve injuries).
Patients who can not tolerate G.A.
Large incarcerated sliding hernia
POTENTIAL COMPLICATIONS OF Laparoscopic
1. Complications related to the
a) Gas embolism
b) Trocar injury (Bl. Vessels, bladder, bowel)
c) Cautery injury (bladder, bowel)
2. Complications related to the repair:
a) Vascular injury
b) Bladder / bowel injury
c) Injury to vas deferens
d) nerve injury
e) migration or infection of prosthesis
f) adhesions and bowel obstruction
g) Seroma formation
Al-Salama Hospital, Jeddah
October,1991 – JUNE,1998
Total no. 59 cases
( OCT. 1991- JUNE 1998 )
ANALYSED 47 CASES
( OCT. 1991- FEB. 1996 )
Unilateral Bilateral Pantalloon
(38) (6) (3)
Indirect 17 (one recurrent)
Rt Direct 1
Indirect 16 (one sliding sigmoid)
Lt. Direct 4
Females 2 (unilateral
left side indirect)
AGE 18 - 78 years
(mean 37 years)
Types of operation
Mesh patch only 7
1. Pre-peritoneal Mesh and cig. 18 (2-7 cig)
Mesh and plugs 6
2. Extraperitoneal 16
Material used Surgipro 7
Unilateral (1.30 – 4 hrs)
fatty patient, big defect
Bilateral (3 – 3.15 hrs)
Pain : Patient given I.M Voltaren and Nubain 4-6 hourly for 24 hours.
All received prophylactic antibiotics for 3 doses post-op.
All discharged with pain killers to be taken PRN.
Same day of op 4
Ambulation 1st post-op day 40
2nd post –op day 3
Hospital stay: (1-7 days) average 2 days
( 7 days for that with D.V.T.)
Return to work: 3 days to 5 weeks (D.V.T.)
( Average 7 days)
Lifting heavy objects : 6 weeks
I. During Surgery:
One case, injury to U.B.
stitched with Vicryl +
catheter for 10 days
- Retension of urine: One case responded to urinary catheterization for
- Neuralgia of upper medial part of thigh (staples)
- Seroma – one case detected by U/S and aspirated from inguinal
- Recurrence (4.2%) = 2 one after 3 months + one after 15 months
- Trocar Hernia - One at umbilical port repaired later on
Continuation : Complications
- Orchitis NONE
- Pelvic collection
- Bowel injury
Length of follow-up
OCT. 1991 – JUNE 1998
( 6 YEARS + 8 MONTHS )
( 80 MONTHS )