Femoral hernia repair – TIPP technique

  • Universitäts Klinik Bonn

    Prof. Dr. Volker Nutz

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  • Anatomy of the inguinal region

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  • Anterior topographical anatomy of the femoral hernia orifice

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  • Posterior aspect of the inguinal region

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  • Transverse section through the femoral hernia orifice

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  • Chirurgische Praxis

    Dr. Karl Heinz Moser

  • Johanniter Krankenhaus

    Dr. Nicola Cerasani

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  • Indication

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  • Contraindications

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  • Preoperative diagnostic work-up

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  • Special preparation

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  • Informed consent

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  • Anesthesia

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  • Positioning

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  • Operating room setup

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  • Special instruments and fixation systems

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  • Postoperative management

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date of publication: 11.05.2012
  • Chirurgische Praxis

    Dr. Karl Heinz Moser

  • Johanniter Krankenhaus

    Dr. Nicola Cerasani

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  • Principle

    118-9-neu

    The principle of this procedure involves closing the femoral hernia orifice with a synthetic mesh implanted via inguinal access. This requires division of the transversalis fascia which is closed subsequently with a simple Shouldice suture.

  • Skin incision

    118-10

    After local anesthesia perform a transverse skin incision of about 4 cm one finger width superior to the inguinal ligament. Transect the subcutaneous tissue and expose the aponeurosis of the external oblique.

  • Splitting the aponeurosis of the external oblique and snaring the round ligament of uterus

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    Now longitudinally divide the fibers of the external oblique, including the superficial inguinal ring. Clamp the edges of the fascia, pull up and dissect off the internal oblique. Expose and snare the round ligament of uterus.

  • Splitting the transversalis fascia and exposing the hernial orifice

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    Split the transversalis fascia. Reduce the hernial sac from the gap between Cooper ligament and inferior margin of inguinal ligament. Bluntly dissect the peritoneum off the anterior pelvic wall.

    Ligate and resect any preperitoneal lipoma encountered here.

  • Trimming and implanting the mesh anterior to the hernial orifice

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    Trim the mesh (in this case an adhesive model) to the appropriate size and implant it such that it will cover the posterior aspect of the hernial orifice. In the video clip note that the usual line of view, “from slightly anteroinferior“, is quickly changed to “from anterosuperior“, in order better view the implanted mesh deep down.

    Note:

    In the case demonstrated here the mesh is self-adhesive; otherwise fixate the mesh to the Cooper ligament with a few sutures.

  • Suturing the transversalis fascia

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    Close the transversalis fascia with a running suture Prolene 2/0.  Another option (see figure) would be a double layered Shouldice suture.

  • Suturing the aponeurosis of the external oblique, subcutaneous tissue and skin

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  • Chirurgische Praxis

    Dr. Karl Heinz Moser

  • Johanniter Krankenhaus

    Dr. Nicola Cerasani

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  • Intraoperative complications

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  • Postoperative complications

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  • Universitäts Klinik Bonn

    Prof. Dr. Volker Nutz

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  • Literature summary

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  • Ongoing trials on this topic

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  • Other literature on this topic

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  • Literature search

    Literature search under: http://www.pubmed.com