The Extended Totally Extraperitoneal (eTEP) hernia surgery repair technique is a novel and advanced approach for the treatment of ventral and inguinal hernias. eTEP is a minimally invasive approach that can be performed laparoscopically or with robotic assistance, rather than being an open surgery technique. This technique was first introduced by Jorge Daes in 2012 and has since been adapted and refined by other surgeons for various types of hernias, including ventral hernias. The eTEP technique is characterized by its minimally invasive approach, which involves creating a large surgical workspace in the extraperitoneal space without entering the abdominal cavity. This is achieved through a series of surgical maneuvers and strategies aimed at enhancing the extraperitoneal work area and allowing for the placement of a larger surgical mesh to repair the hernia defect. The eTEP Hernia Repair Technique Procedure StepsThe procedural steps for an eTEP (Extended Totally Extraperitoneal) hernia repair can vary depending on the type of hernia being treated (inguinal, ventral, or lumbar). However, the general steps for the eTEP approach are as follows:
Key Features of eTEP Hernia Surgery
Advantages of eTEP Technique for Hernia Repair
What are the success rates of eTEP hernia repair?Here are the key findings from a recent study, explained in laypersons’ terms: The study involved surgeons who did eTEP hernia surgery on 150 patients over three years. Out of the 150 patients:
Most of the patients were females (74%). Primary hernias happened equally in males and females, but incisional and recurrent hernias were more common in females. For smaller hernias, doctors used a method called eTEP RS (Rives-Stoppa). For larger hernias, they used eTEP TAR which also relaxes some muscles to help close the hernia. The eTEP RS repair took about 2 hours to do, while eTEP TAR took about 3.5 hours. After the surgery:
This study shows the eTEP method worked well to repair different kinds of hernias, even complicated ones, with few problems afterward. The study reports it is a good option, especially for hernias on the sides of the belly. Surgeons need a lot of special training to do it well. Dr. Mazen Iskandar is thoroughly trained and experienced in eTEP surgery. You can view a video of Dr. Iskandar performing a complex eTEP procedure (Note: contains images of surgery). What types of hernias can be repaired with the eTEP technique?The eTEP (Extended Totally Extraperitoneal) technique can be used to repair various types of hernias, including:
What kind of hernias cannot be treated with eTEP?There are certain situations where the eTEP technique might not be the best choice or could be contraindicated:
Final ThoughtsThe eTEP hernia surgery repair technique represents a significant advancement in the field of hernia repair. Its minimally invasive nature, combined with the strategic placement of mesh and the potential for component separation, offers a comprehensive solution for hernia repair that is associated with improved patient outcomes, including reduced complication rates, faster recovery times, and lower recurrence rates. Surgeons seeking to adopt this technique should have detailed knowledge of the anatomy of the extraperitoneal space and undergo formal training, ideally including practice on fresh cadavers under mentorship, to ensure the safety and effectiveness of the procedure.
Via https://iskandarcenter.com/hernia-surgery/extended-totally-extraperitoneal-etep-hernia-repair-technique/
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Undergoing hernia repair surgery is an important step towards regaining your health and improving your quality of life. Dr. Iskandar and the team at The Iskandar Complex Hernia Center understand that post-operative recovery is just as crucial as the surgery itself. One common concern many patients face after hernia repair is constipation, a condition that can add discomfort and delay recovery. In this article, we’ll share effective strategies to prevent constipation, ensuring a smoother and more comfortable recovery process. 10 Tips to Avoid Constipation After Hernia RepairEnsuring a comfortable recovery after hernia repair surgery at The Iskandar Complex Hernia Center involves managing post-operative constipation effectively. Dr. Iskandar and his team prioritize patient education on preventive measures to maintain digestive health. Here are 10 strategies to maintain regular bowel movements and ensure a comfortable recovery:
Will having a bowel movement after hernia repair be painful?After hernia repair surgery, it’s normal to experience some level of pain and discomfort, particularly in the area of the repair when moving, which may affect how easily you can have a bowel movement. This could happen anytime from one to ten days after the surgery. Anesthesia used during surgery can also slow the gastrointestinal tract. It’s important to avoid straining or forcing a bowel movement during this time to prevent excess pressure on the hernia repair. Instead, we advise patients to relax, perhaps with a book or phone in hand, to allow the body to proceed naturally. Having a bowel movement after hernia repair surgery is a common concern among patients at The Iskandar Complex Hernia Center, primarily due to the potential discomfort . Dr. Iskandar and his team are committed to ensuring that each patient’s recovery process is as smooth and pain-free as possible, emphasizing the importance of managing expectations and following post-operative guidelines to minimize discomfort. To manage pain and encourage gentle bowel movements, we recommend several strategies. Utilizing stool softeners post-surgery can soften stools, making them easier to pass without straining. Maintaining hydration and adhering to a high-fiber diet are also key in preventing constipation, which in turn facilitates smoother bowel movements. Moreover, engaging in light physical activities, such as walking, can stimulate the digestive system, supporting regular bowel movements without overexertion. Always communicate openly with your surgeon about any concerns or unusual symptoms so that you can receive personalized advice and support. Dr. Iskandar and the team at The Iskandar Complex Hernia Center are here to guide you through your recovery, ensuring a comfortable and safe return to normalcy. Experience renowned expertise and unparalleled compassion from the leader in hernia repair.More FAQ’s About How to Avoid Constipation After Hernia RepairWhat foods should I avoid to prevent constipation after hernia repair?Dr. Iskandar recommends avoiding foods that can exacerbate constipation following hernia repair. These include highly processed foods, red meat, dairy products, and sweets. Such foods are low in fiber and can slow down digestion. He advises focusing on a balanced diet rich in fruits, vegetables, and whole grains to support smoother bowel movements and a more comfortable recovery. What are some natural remedies to relieve constipation after hernia repair?To naturally relieve constipation after hernia repair, Dr. Iskandar suggests several effective remedies. Increasing your intake of water and fiber-rich foods is fundamental. Additionally, warm liquids in the morning, such as herbal tea, can stimulate digestion. Gentle exercise, like walking, is also beneficial. Dr. Iskandar may recommend specific herbal supplements or probiotics, but it’s important to consult with him before trying any new remedy to ensure it complements your recovery plan. What specific foods should I eat to prevent constipation after hernia repair surgery?Dr. Iskandar recommends focusing on a diet rich in fiber to prevent constipation post-hernia repair. Incorporate fruits like pears and apples, vegetables such as leafy greens and carrots, whole grains, and legumes. Dietary fiber helps maintain the health of the gastrointestinal tract and facilitates the passage of human feces. Eating fiber rich foods help increase stool bulk and promote regular bowel movements. Can I use over-the-counter laxatives immediately after my hernia surgery to prevent constipation?Dr. Iskandar advises against using over-the-counter laxatives to encourage defecation without prior consultation. While they may seem helpful, they can interfere with your recovery process. It’s best to discuss with him about the safest options for your specific case. How does water intake influence constipation after hernia repair?Adequate hydration is crucial for preventing constipation after hernia repair, as explained by Dr. Iskandar. Water helps soften stool, making it easier to pass. He recommends drinking at least eight glasses of water a day to facilitate bowel movements and aid recovery. Is it normal to feel pain during bowel movements after hernia repair surgery?Some discomfort or slight pain during the first few bowel movements post-surgery is normal. Analgesic medications, such as Ibuprofen and Paracetamol, can alleviate pain associated with bowel movements post-surgery. However, Dr. Iskandar emphasizes that extreme pain, nausea or fever is not and could indicate complications. If you experience significant pain, contact The Iskandar Complex Hernia Center immediately. How long after hernia repair surgery can constipation last?Constipation duration varies among patients, but it’s generally temporary. Dr. Iskandar notes that most patients see improvement within the first week as they adjust their diet and hydration levels and gradually increase physical activity. Are there any specific exercises I can do to prevent constipation after my hernia repair?Dr. Iskandar recommends gentle walking as the safest exercise to prevent constipation post-surgery. Start with short walks and gradually increase as comfortable. Avoid strenuous activities that strain the abdomen until he clears you for such exercises. How does pain medication after hernia surgery affect constipation?Pain medications, especially opioids, can lead to constipation by slowing down the digestive system. Certain narcotics, a type of prescription drug used for pain management after surgery, can lead to constipation as a side effect, which is why it is important to closely manage medication intake. Dr. Iskandar advises staying hydrated, eating fiber-rich foods, and discussing stool softeners as preventive measures during your recovery period. Docusate is an example of an over-the-counter drug that can be used under the guidance of Dr. Iskandar to soften stools and prevent straining during bowel movements. Can stress after hernia repair surgery contribute to constipation?Yes, stress can impact your digestive system and contribute to constipation. Dr. Iskandar encourages practices such as deep breathing, meditation, or gentle yoga to manage stress and support a healthy digestive process during your recovery. What are the signs that constipation after hernia repair is severe and requires medical attention?If you experience no bowel movements for more than three days, severe abdominal pain, bloating, or symptoms of bowel obstruction, Dr. Iskandar stresses the importance of seeking immediate medical care to prevent complications. Can altering the timing of pain medication intake help manage constipation after hernia repair? Adjusting the timing of your pain medication can sometimes help, but it should not be done without consulting Dr. Iskandar. He may offer alternative pain management strategies or adjust your medication to alleviate constipation without compromising pain control. Via https://iskandarcenter.com/hernia-surgery/how-to-avoid-constipation-after-hernia-repair/ Combo Robotic eTEP Recurrent Incisional Hernia Repair with Spine Access for L4-L5 ALIF Video3/12/2024 <iframe title=”vimeo-player” src=”https://player.vimeo.com/video/922170347?h=83dddaed03″ width=”640″ height=”360″ frameborder=”0″ allowfullscreen></iframe> Transcript of Narration Presenting a robotic eTEP recurrent incision hernia repair in combination with spine axis for an L4-L5 anterior lumbar antibody fusion ALIF. So this is a patient who had a recurrent hernia following colectomy. The hernia was 5 cm and was below a previously placed mesh. We obtained access to the… Given that we normally do spine access for L4 or L5 from the left side to avoid the IVC, we planned on a right-sided eTEP with three trocars at the semi lunar line, as well as a pre-costal axis, which is later used as an assistant trocar. Also, the patient had a left lower quadrant colostomy. Right side, in order to have good visualization of the retroperitoneal axis, that’s going to be done over on the left side. The patient had quite a bit of adhesions into the retromuscular space related to previous mesh fixation. The literature is very useful in those instances. You can see here some mesh fixation sutures. After the docking on the right side, we have incised here the right posterior rectus sheath and entering the prepared needle space behind the falsiform and identified the contralateral left-sided posterior rectus sheath and will incise and enter the left posterior rectus sheath. One of the challenges was mobilization of the previously placed mesh. And here we are taking some adhesions into the preperitoneal space and reducing the lower hernia and incising the left posterior rectus sheath. Then the hernia contents which mostly contained omentum and preperitoneal fat were completely mobilized and reduced. And we proceeded with the vision of the posterior rectus sheath. Here is the patient’s previous colostomy site where there is a defect in the posterior rectus sheath which will be reconstructed at the end of the dissection. We then proceeded with developing the left space of Bogros and posterior rectus sheath release, similar to a bottoms up TAR. We would want to release the posterior rectus sheath to the lever of L4-L5 which had been marked using fluoroscopy at the beginning of the case. Similar to a TAR again, very similar dissection here. And then entering the correct plane here in front of the psoas, the idea was to try to mobilize as much as possible, given the patient’s central obesity and to minimize the amount of dissection needed in a small hole and to minimize the length of the incision that was needed. This exposure won’t allow us to reach the spine unless the patient is in a lateral position. But we were able to complete a good amount of dissection, which greatly facilitated the exposure once we made our lower abdominal incision. Here I’m just showing some pictures of the setup that we had. We had a large room that had all the spine instruments and the robot. And as you can see here, we placed the cage between L4 and L5. On the right side, you can see the cage behind the left common iliac. And then using that incision, we placed a 30 by 18 centimeter medium-weight polypropylene mesh into the retromuscular space. Thank you for watching. Via https://iskandarcenter.com/hernia-surgery/combo-robotic-etep-recurrent-incisional-hernia-repair-with-spine-access-for-l4-l5-alif-video/ The Bassini hernia repair, developed by Italian surgeon Edoardo Bassini in the late 19th century, represents a significant historical advancement in the surgical treatment of inguinal hernias. Although this hernia repair technique has largely been replaced by modern methods, particularly tension-free mesh repairs, it remains a critical part of surgical history and education. The Bassini repair was revolutionary, reducing hernia recurrence rates dramatically compared to prior methods. It is based on the anatomical reconstruction of the inguinal canal by suturing the conjoint tendon to the inguinal ligament, aiming to restore the normal anatomy without the use of mesh. The Foundation of Tension-Free RepairUnlike the tension-free repairs that have become the standard in modern hernia surgery, the Bassini technique relies on creating tension by suturing tissues together. This was intended to restore the integrity of the inguinal canal’s posterior wall but contrasts sharply with the principles of tension-free repair that minimize recurrence and postoperative pain. The Role of Surgical Technique and Mesh IntegrationThe key features of the Bassini repair include its avoidance of prosthetic materials and its reliance on the patient’s own tissues to repair the hernia defect. This method does not utilize mesh, setting it apart from contemporary techniques, which use synthetic materials to reinforce the repair site and support tissue integration. The Bassini Technique Procedural StepsThe procedural steps involved in the historic Bassini technique included:
Advantages and ConsiderationsThe Bassini method offered advantages such as avoiding mesh-related complications, but it also presented significant disadvantages, including higher recurrence rates and increased postoperative pain due to the tension on sutured tissues. These limitations have led to its decline in use in favor of tension-free mesh repairs. Experience renowned expertise and unparalleled compassion from the leader in hernia repair.Types of Hernias Suitable for the Bassini TechniqueThe Bassini repair was historically utilized for indirect and direct inguinal hernias. These are hernias that appear in the groin area, either following the pathway of the inguinal canal (indirect) or resulting from a weakness in the inguinal canal floor (direct). Types of Hernias Not Typically Repaired with the Bassini TechniqueThe Bassini technique is not suitable for repairing femoral hernias, incisional hernias, umbilical hernias, hiatal hernias, or large or complex hernias. These types of hernias require different surgical approaches, often involving mesh or more advanced techniques due to their anatomical locations or complexities. Comparison of the Bassini Tension-Free Mesh Hernia Repair with Other TechniquesWhen compared to the Lichtenstein tension-free mesh repair and other modern techniques, the Bassini repair has fallen out of favor due to its higher recurrence rates and the postoperative discomfort associated with tension repairs. Tension-free mesh repairs, including the Lichtenstein method, provide more durable reinforcement of the inguinal canal and allow for quicker recovery times with less postoperative pain. Laparoscopic mesh repairs offer a minimally invasive alternative with even faster recovery, although they require general anesthesia, contrasting with the local or regional anesthesia that can be used for the Bassini repair. In contrast, the Shouldice repair, another tension-based method, offers an improved recurrence rate over the Bassini technique through a more complex four-layer reconstruction but still does not match the effectiveness of tension-free mesh repairs. Dr. Iskandar’s ThoughtsBassini is mostly used these days in the emergency setting as a bailout option when mesh-based repairs are not doable due to the risk of infection, as in the case of strangulated hernias. It is rarely performed in the elective setting, where the shouldice method is preferred in my practice. ConclusionIn summary, the Bassini hernia repair technique, while an important step in the evolution of hernia surgery, has been largely superseded by methods that reduce the risk of recurrence and enhance patient recovery. Its use in modern surgical practice is limited to specific scenarios where mesh is contraindicated or unavailable. The development and adoption of tension-free mesh repairs have set a new standard in hernia surgery, reflecting ongoing advancements in surgical techniques and materials. Via https://iskandarcenter.com/hernia-surgery/the-bassini-hernia-repair-technique/ The Lichtenstein tension-free mesh repair is a pioneering surgical technique developed in the 1980s by Dr. Irving L. Lichtenstein. This method has transformed the landscape of inguinal hernia surgery, offering patients a highly effective treatment option with a focus on reducing recurrence rates and facilitating a quicker return to daily activities. This article delves into the key features, benefits, and considerations of the Lichtenstein repair, shedding light on why it’s considered a gold standard in hernia surgery. The Foundation of Tension-Free RepairAt the heart of the Lichtenstein method is the principle of a tension-free repair. Traditional hernia repairs, which involved suturing the hernia defect closed under tension, often resulted in higher recurrence rates due to the forces exerted on the repair site during normal activities. The Lichtenstein technique avoids this pitfall by using a synthetic mesh to bridge the defect, distributing forces evenly and significantly lowering the risk of the hernia re-opening. The Role of Surgical Technique and Mesh IntegrationThe surgical procedure for the Lichtenstein repair is meticulous and standardized, involving a small incision in the groin to expose the hernia, preparation of the hernia sac, and the strategic placement of a synthetic mesh over the defect. This mesh is then secured to the surrounding healthy tissue, extending beyond the edges of the defect to ensure comprehensive coverage and integration with the body’s tissues. The success of this method is also attributed to the mesh’s ability to integrate with the patient’s tissues. Made from materials like polypropylene, the mesh acts as a scaffold that encourages tissue ingrowth, resulting in a stronger, integrated repair site that is less likely to succumb to the pressures that caused the hernia initially. The Lichenstein Hernia Repair Technique Procedural StepsBelow is a procedural breakdown of the Lichtenstein hernia repair:
Advantages and ConsiderationsThe Lichtenstein tension-free mesh repair boasts several advantages, including a reduced risk of recurrence, lower postoperative pain, quick recovery, and the possibility of performing the surgery under local anesthesia. These benefits make it an appealing option for both surgeons and patients alike. However, it’s important to recognize that the Lichtenstein repair, while versatile, is not suitable for all types of hernias or patients. Factors such as the patient’s overall health, the specific characteristics of the hernia, and the surgeon’s expertise play crucial roles in determining the most appropriate surgical approach. Moreover, as with any procedure involving mesh, there’s a small risk of complications such as infection, mesh migration, or chronic pain, though these are relatively rare. Types of Hernias Suitable for Lichtenstein Tension-Free Mesh RepairThe Lichtenstein tension-free mesh repair is primarily used for the repair of inguinal hernias, which are hernias occurring in the groin area. This includes:
Types of Hernias Not Typically Repaired with Lichtenstein Tension-Free Mesh RepairWhile the Lichtenstein repair is versatile, there are certain types of hernias for which it is not typically used:
Complex or Large Abdominal Wall Hernias: Large or complicated hernias may require more complex reconstructive techniques that can involve mesh but are not performed using the Lichtenstein method. In summary, the Lichtenstein tension-free mesh repair is most commonly used for inguinal hernias due to its effectiveness in this area. It is not the preferred method for other types of hernias, which may require different surgical approaches tailored to their specific anatomical challenges and considerations. The choice of hernia repair technique is ultimately determined by the type and location of the hernia, the patient’s overall health, and the surgeon’s expertise and preference. Comparison of the Lichtenstein Tension-Free Mesh Hernia Repair with Other TechniquesWhen compared to other surgical options, such as laparoscopic mesh repair or other open mesh techniques, the Lichtenstein repair stands out for its simplicity, effectiveness, and adaptability. While laparoscopic repairs offer a minimally invasive alternative with potentially quicker recovery times, they require general anesthesia and are not suitable for all patients. Other open mesh repairs, varying in mesh placement and fixation, share the tension-free principle with the Lichtenstein method but may not match its low recurrence rates and overall reliability. Dr. Iskandar’s Thoughts on the TechniqueThis technique has been reproducible across the world with lots of evidence and data on its safety and effectiveness. It is also suitable for the majority of inguinal hernia irrespective of their size. For that reason, it is the go-to open-repair technique for many surgeons. ConclusionIn conclusion, the Lichtenstein tension-free mesh repair remains a cornerstone in the surgical management of inguinal hernias. Its blend of a tension-free approach, meticulous surgical technique, and mesh integration with the patient’s tissues offers a durable solution that minimizes recurrence and enhances patient recovery. As with any medical procedure, the decision to opt for the Lichtenstein repair should be made after careful consideration of the patient’s specific situation and in consultation with a skilled surgeon. View the entire hernia repair technique library.
Via https://iskandarcenter.com/hernia-surgery/lichtenstein-tension-free-mesh-hernia-repair/ The McVay hernia repair, historically known as the Cooper’s ligament repair, is a surgical approach developed for the treatment of inguinal (relating to the groin) and femoral (relating to the upper thigh) hernias. Pioneered by Dr. Chester McVay, this technique is distinguished by its utilization of Cooper’s ligament, offering an alternative to other hernia repair methods. Despite the evolution of surgical practices favoring tension-free mesh repairs, understanding the McVay technique is crucial for surgeons, especially in scenarios where mesh use is contraindicated (not recommended) or unavailable. Key Features of the McVay RepairAnatomical RestorationThe essence of the McVay repair lies in its anatomical approach, which involves suturing the transversus abdominis arch (a muscle layer in the abdominal wall) and the conjoint tendon (a tendinous structure formed by the joining of two muscles) directly to Cooper’s ligament (the periosteum of the pubic bone). This method aims to reconstruct the groin’s anatomy robustly and durably. Tension-Based TechniqueSimilar to the traditional Bassini repair, the McVay method is a tension repair. It requires suturing tissues under tension, which can increase the risk of postoperative discomfort and hernia recurrence compared to tension-free alternatives. Efficacy in Femoral Hernia RepairsThe technique is notably effective for femoral hernia repairs due to its specific reinforcement of the femoral canal, addressing a common and challenging type of hernia. The McVay Technique Procedural StepsThe McVay hernia repair, known as well for its designation as the Cooper’s ligament repair, represents a traditional surgical method primarily employed in the treatment of inguinal and femoral hernias. This technique emphasizes the anatomical restoration of the groin’s structure by suturing the transversus abdominis arch and the conjoint tendon directly to Cooper’s ligament. Below is a detailed walkthrough of the McVay technique’s procedural steps:
Advantages and DisadvantagesAdvantages of McVay Technique
Disadvantages
Current Clinical ApplicationWhile the advent of tension-free mesh repairs has led to a decline in the McVay technique’s prevalence, it retains significance in certain contexts. It is particularly relevant for patients unable to undergo mesh repairs and in settings where mesh is not accessible. Its historical and educational value continues to enrich the surgical community’s knowledge, especially for managing femoral hernias and in situations where mesh alternatives are sought. Comparative Analysis with Other Hernia Repair TechniquesMcVay Technique vs. Lichtenstein Tension-Free Mesh RepairThe McVay repair’s tension-based approach contrasts with the Lichtenstein method’s tension-free, mesh-reinforced technique, which generally offers lower recurrence rates and reduced postoperative pain. McVay Technique vs Laparoscopic Hernia RepairCompared to minimally invasive laparoscopic techniques (surgery performed through small incisions using a camera), the McVay repair, being an open surgery, involves a larger incision and a potentially longer recovery period. McVay Technique vs Shouldice RepairWhile both the McVay and Shouldice repairs are tension-based, the Shouldice technique focuses on a four-layer reconstruction specifically for inguinal hernias, without employing mesh. Dr. Iskandar’s RemarksIn current practice, the utility of McVay is mostly in emergency situations when there is a strangulated femoral hernia (a hernia that becomes trapped and loses blood supply). In that scenario, there is risk of mesh infection and a McVay repair would be the tissue method of choice to repair the femoral hernia. ConclusionThe McVay hernia repair technique, with its unique application and historical significance, remains a valuable part of surgical education and practice. Although modern tension-free mesh and minimally invasive approaches have largely superseded it, the McVay repair persists as a viable option under specific circumstances. Its understanding is essential for surgeons, offering insights into the evolution of hernia repair techniques and providing alternatives in complex clinical scenarios. See the entire hernia repair techniques library. Via https://iskandarcenter.com/hernia-surgery/mcvay-hernia-repair-technique/ The Transabdominal Preperitoneal (TAPP) technique is a minimally invasive method that offers a quicker recovery and less pain than traditional hernia surgeries. This guide breaks down the TAPP procedure into understandable parts. What is TAPP?The TAPP technique repairs inguinal hernias using small incisions, cameras, and a mesh. It’s done by accessing the hernia from inside the abdomen but placing the mesh in the preperitoneal space (the area between the abdominal wall and the peritoneal lining). The TAPP Hernia Repair Technique Procedure Steps
Benefits of TAPP Hernia Repair
Limitations of TAPP Hernia Repair
Considerations for Mesh Use
In summary, the TAPP hernia repair technique presents a significant advancement over conventional open surgeries, offering benefits such as diminished postoperative pain and expedited recovery. Nonetheless, it demands specialized skills from the surgeon and carries its own set of risks that must be carefully weighed. The selection of mesh material further influences the surgical outcome, underscoring the importance of tailored surgical planning. Laparoscopic vs. Robotic TAPPThe steps for both laparoscopic (using special tools and a camera) and robotic TAPP (using a robot the surgeon controls) are similar. The main difference is the use of a robotic system in the latter, which may enhance precision and control. Why Will a Hernia Surgeon Choose TAPP?TAPP is less invasive than traditional surgery, leading to:
What Types of Hernias are Suitable for TAPP?Inguinal Hernias: These are hernias near the groin. TAPP is great here because it lets doctors place a special kind of patch (mesh) in just the right spot to cover the hernia. Femoral Hernias: Similar to inguinal hernias but in a slightly different area, TAPP can also tackle these effectively. Incisional Hernias (sometimes): If you’ve had surgery before and get a hernia at the scar site, TAPP might be an option, especially for smaller ones in the lower belly. Hernia Types Not Typically Ideal for TAPPBig or Complicated Hernias in the Belly Wall: If the hernia is really big or tricky, doctors might go for a different method that involves more detailed work. Hiatal Hernias: These occur near the diaphragm (the muscle that helps you breathe) and need a different fix. Umbilical Hernias: These are at the belly button and don’t fit the TAPP approach, but there are other laparoscopic (small incision surgery) methods that might work. Understanding Your Options: TAPP vs. TEPWhen it comes to repairing inguinal hernias with a minimally invasive approach, patients and surgeons often choose between two primary techniques: Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP) repair. Both methods have their unique advantages and considerations. Understanding the differences can help in making an informed decision tailored to individual needs. TAPP (Transabdominal Preperitoneal) RepairTAPP involves entering the abdominal cavity to place a mesh in the preperitoneal space, effectively reinforcing the weakened area. This approach allows the surgeon to have a broad view of the abdominal cavity, potentially identifying and addressing other abdominal issues if present. It is versatile and can be used for almost all types of inguinal hernias, including those that are recurrent or complicated by previous surgeries. Advantages of TAPP:
TEP (Totally Extraperitoneal) RepairTEP, on the other hand, avoids entering the abdominal cavity altogether. The procedure is conducted entirely in the preperitoneal space, directly addressing the hernia without the potential complications associated with abdominal cavity access, such as injury to the intestines or other intra-abdominal organs. Advantages of TEP:
Choosing Between TAPP and TEPThe choice between TAPP and TEP is influenced by several factors, including:
Dr. Iskandar’s Remarks on TAPPThis is an excellent minimally invasive repair. For women specifically, minimally invasive surgery is recommended as it allows mesh coverage of all potential hernia defects (indirect, direct, femoral, and obturator) as women have a higher chance of femoral and obturator hernias ConclusionIn conclusion, the Transabdominal Preperitoneal (TAPP) hernia repair technique stands out as a minimally invasive option that offers numerous benefits, including reduced recovery time and lower risk of complications. It’s particularly effective for repairing inguinal and femoral hernias, making it a versatile choice for many patients. While it may not be suitable for all types of hernias, its ability to allow surgeons to place mesh in the preperitoneal space accurately makes it an invaluable option in the surgical toolbox. The decision to use TAPP over other methods depends on various factors, including the specific characteristics of the hernia and the surgeon’s expertise, highlighting the importance of a tailored approach to hernia repair. See all the hernia repair techniques library.
Via https://iskandarcenter.com/hernia-surgery/transabdominal-preperitoneal-tapp-hernia-repair/ In this video, Dr. Mazen Iskandar narrates a robotic pre-peritoneal umbilical hernia repair. This is a frequently performed procedure because umbilical hernias are one of the most common type of hernias. More about Robotic Pre-peritoneal Hernia RepairA robotic pre-peritoneal hernia repair is a minimally invasive surgical procedure used to treat hernias. This technique involves the use of a surgical robot, which the surgeon controls from a console to perform precise movements and repair the hernia. The procedure is performed through small incisions, which typically results in less bleeding, less postoperative pain, and a shorter recovery time compared to traditional open surgery In a pre-peritoneal hernia repair, the inner layer of the abdominal wall, known as the peritoneum, is partially separated from the abdominal wall itself to create a “pocket” for the placement of a reinforcing mesh. This mesh placement in the pre-peritoneal space is a key aspect of the procedure, as it helps to reinforce the abdominal wall and prevent the recurrence of the hernia The robotic approach to pre-peritoneal hernia repair offers several advantages over traditional laparoscopic techniques. These include improved access to the different layers of the abdominal wall, better ergonomics, greater freedom of instrumentation, and increased image stability Via https://iskandarcenter.com/hernia-surgery/robotic-umbilical-hernia-repair-video-dr-mazen-iskandar-narrates-the-procedure/ In this video, Dr. Mazen Iskandar narrates a robotic pre-peritoneal umbilical hernia repair. This is a frequently performed procedure because umbilical hernias are one of the most common type of hernias. More about Robotic Pre-peritoneal Hernia RepairA robotic pre-peritoneal hernia repair is a minimally invasive surgical procedure used to treat hernias. This technique involves the use of a surgical robot, which the surgeon controls from a console to perform precise movements and repair the hernia. The procedure is performed through small incisions, which typically results in less bleeding, less postoperative pain, and a shorter recovery time compared to traditional open surgery In a pre-peritoneal hernia repair, the inner layer of the abdominal wall, known as the peritoneum, is partially separated from the abdominal wall itself to create a “pocket” for the placement of a reinforcing mesh. This mesh placement in the pre-peritoneal space is a key aspect of the procedure, as it helps to reinforce the abdominal wall and prevent the recurrence of the hernia The robotic approach to pre-peritoneal hernia repair offers several advantages over traditional laparoscopic techniques. These include improved access to the different layers of the abdominal wall, better ergonomics, greater freedom of instrumentation, and increased image stability Via https://iskandarcenter.com/hernia-surgery/robotic-umbilical-hernia-repair-video-dr-mazen-iskandar-narrates-the-procedure/ One of Only Two Designated Hernia Centers of Excellence in North TexasThe Iskandar Complex Hernia Center of the Baylor Scott & White Center for Hernia Surgery has been designated as one of only two Hernia Centers of Excellence in North Texas by the Surgical Review Corporation (SRC). SRC is a nonprofit patient safety organization committed to healthcare excellence that accredits providers worldwide. The qualifications that must be met to earn the Center of Excellence designation are rigorous. The Hernia Center is led by Mazen Iskandar, MD FACS. This distinction is a significant achievement, indicating the center’s superior quality of care and its commitment to excellence in hernia surgery. What Does This Mean for You as a Patient?As a patient, the accreditation of the Iskandar Complex Hernia Center by SRC as a Center of Excellence in Hernia Surgery means receiving care at a facility adhering to the highest standards. This designation ensures the center’s commitment to excellence in all facets of hernia surgery, including a high volume of successful surgeries and comprehensive patient care. It also indicates that the center has a well-trained and experienced surgical team, state-of-the-art equipment, and a patient education system that prioritizes informed consent and procedure selection based on each patient’s condition. Furthermore, the continuous quality assessment and adherence to SRC’s rigorous standards guarantee that patients receive the most advanced and safe hernia treatment available. How SRC Determines Its Centers of Excellence
Rigorous Standards for ExcellenceTo be designated as a Center of Excellence, the Iskandar Complex Hernia Center has met stringent requirements. These include a commitment to excellence, a high volume of hernia surgeries, an experienced surgical team, comprehensive consultative services, advanced equipment and instruments, dedicated surgeons with ongoing education, standardized operating procedures, skilled support staff, robust patient education programs, and continuous quality assessment. This rigorous evaluation ensures that every aspect of hernia care at the center is of the highest quality. Why Choose The Iskandar Complex Hernia CenterChoosing the Iskandar Complex Hernia Center for your hernia surgery means entrusting your health to a facility that is recognized for its excellence. The center’s adherence to SRC’s demanding standards ensures that patients receive the most advanced and comprehensive care. The dedication to continuous improvement and patient education ensures that you, as a patient, will be well-informed and receive personalized care tailored to your specific needs. In summary, the designation of the Iskandar Complex Hernia Center as a Hernia Center of Excellence by SRC is a clear indicator of its superior quality and commitment to patient care, making it a prime choice for anyone seeking the best in hernia treatment. Dr. Mazen Iskandar Also Named Surgeon of Excellence in Hernia Surgery by SRCIn addition to the center being named a Center of Excellence, Dr. Iskandar himself was awarded the Surgeon of Excellence in Hernia Surgery Accreditation by SRC, making him one of a handful of hernia surgeons in the United States with such a designation. Learn more about this achievement.
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About UsThe Iskandar Complex Hernia Center offers complex hernia surgery and advanced abdominal procedures with unparalleled compassion and renowned expertise, so you can enjoy a dramatically improved quality of life. Follow Us
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