Perioperative management - Transabdominal preperitoneal patch (TAPP) repair of inguinal hernia - general and visceral surgery

Elective:

• Recurrent hernia following anterior access
• Bilateral hernias

Alternative procedures:

• In recurrent inguinal hernia: Lichtenstein
• In bilateral inguinal hernias: Depending on the wish of the patient one or two stage procedure, and on the age of the patient:
• patients > 30 years –  Lichtenstein repair, patients aged < 30 years –  Shouldice repair.

• Risk factors ruling out general anesthesia and pneumoperitoneum
• Abdominal wall infections
• Intestinal necrosis/perforation
• Known foreign body (mesh) allergies 

Relative contraindications are:

• Large scrotal hernia
• Previous intraperitoneal and extraperitoneal surgery in the lower abdomen
• Previous mesh implantation

• Manual examination with patient standing
• In men > 50 years, digital rectal examination ruling out rectal cancer.
• Ultrasonography

• Mark the side of the hernia examined with the patient standing
• 1/2 hour before skin incision single-shot administration of 2^nd generation cephalosporin

• Recurrence
• Seroma
• Hematoma
• Secondary healing
• Infection
• Mesh infection
• Vascular and nerve injury
• (Secondary) bleeding
• Chronic groin pain such as ilioinguinal syndrome
• Injury to the spermatic cord
• Testicular atrophy
• Redo procedure
• Bowel resection
• Death
• Injury to vessels/hollow viscus with laparoscopic instruments
• Trocar hernias
• Conversion to open procedure