Perioperative management - Transabdominal preperitoneal patch (TAPP) repair of inguinal hernia

  1. Indications

    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.
  2. Contraindications

    • 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
  3. Preoperative diagnostic work-up

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

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

RecurrenceSeromaHematomaSecondary healingInfectionMesh infectionVascular and nerve injury(Secondary

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