anatomy & technique of the laparoscopic totally extra peritoneal
TRANSCRIPT
![Page 1: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/1.jpg)
1
Anatomy & technique of the Laparoscopic Totally Extra-peritoneal approch for inguinal hernia repair .DR/ M.M. BOUGHRARA® . 20/4/2017
![Page 2: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/2.jpg)
2
Agenda :
Preparation & positioning . Access to pre –peritoneal space . “space creation”. Surgical anatomy . Dissection . Mesh placement .
![Page 3: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/3.jpg)
3
•CASE SELECTION :
![Page 4: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/4.jpg)
4
CASE SELECTION :
![Page 5: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/5.jpg)
5
CASE SELECTION :
![Page 6: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/6.jpg)
6
CASE SELECTION :
![Page 7: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/7.jpg)
7
Indications :
Recurrent hernia after previous anterior repair .
Bilateral hernias . Repair of an inguinal hernia
concurrent with another laparoscopic procedure , provided that there is no contamination .
![Page 8: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/8.jpg)
8
Contraindications :
Acutely incarcerated hernias . In patients to whom general
anesthesia may pose an increased risk .
Infant & young children . Previous lower abdominal surgery . Previous pelvic irradiation therapy .
![Page 9: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/9.jpg)
9
Disadvantages :
Need for general anaesthesia . High cost . Longer duration time . Steeper learning curve . High recurrence and complication
rates early in a surgeon’s experience .
![Page 10: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/10.jpg)
10
Idea .
TAPP TEP
![Page 11: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/11.jpg)
11
Idea :
![Page 12: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/12.jpg)
12
![Page 13: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/13.jpg)
13
Avoid injury :1. Inf . Epigastric
vesseles .2. Pectineal lig.3. Ilio-pubic tract
.4. Cut. Nerves on
psoas muscle . 5. Peritoneal
reflection .6. Urogenital
fascia. 7. Vas. &
spermatic vessels .
![Page 14: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/14.jpg)
14
![Page 15: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/15.jpg)
15
![Page 16: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/16.jpg)
16
Operative planning :
•Preparation .•Postion .
![Page 17: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/17.jpg)
17
Steps :
Trocars placement .
![Page 18: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/18.jpg)
18
Steps :
Creation of preperitoneal space .
![Page 19: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/19.jpg)
19
Steps :
Creation of preperitoneal space .
![Page 20: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/20.jpg)
20
Steps :
Creation of preperitoneal space .
![Page 21: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/21.jpg)
21
Steps :
Creation of preperitoneal space .
![Page 22: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/22.jpg)
22
Steps :
Dissection of hernial sac .
![Page 23: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/23.jpg)
23
Steps :
Dissection of hernial sac .
![Page 24: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/24.jpg)
24
Steps :
Dissection of hernial sac .
![Page 25: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/25.jpg)
25
Stepes :
![Page 26: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/26.jpg)
26
Steps :
![Page 27: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/27.jpg)
27
Steps :
Placement of mesh .
![Page 28: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/28.jpg)
28
Steps :
Placement of mesh .
![Page 29: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/29.jpg)
29
Steps :
Placement of mesh .
![Page 30: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/30.jpg)
30
Steps :
Placement of mesh .
![Page 31: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/31.jpg)
31
Steps :
Placement of mesh .
![Page 32: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/32.jpg)
32
Steps :
Mesh fixation .
![Page 33: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/33.jpg)
33
Steps :
Mesh fixation .
![Page 34: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/34.jpg)
34
Complications :
Complications of access……… trocars . injury to bladder , bowel , vessles &
trocars hernia. Complications of dissection ……. Bleeding ,
vas , sp. Vesseles . Complications related to mesh ……… infection , migration , adhesion . Vas deferens and testicular complications.. testicular swelling , orchitis and ischemic
atrophy.
![Page 35: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/35.jpg)
35
Complications :
Postoperative groin and thigh pain. Miscellaneous complications .
![Page 36: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/36.jpg)
36
VIDEO DEMONSTRATION :
![Page 37: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/37.jpg)
37
REFERENCES : Abdominal wall repair center Samaritano Hospital , SAO
PAULO,BRAZIL. Master in minimal access laparoscopic surgery , DR .
Mishra® 2007 . World Laparoscopy Hospital. Philippine Journal of surgical specialities . www.emedicine.medscape.com. HERNIA+ , Modern techniques in hernia repair surgery . AL JALA HOSPITAL, Benghazi , Libya , emergency OT.
2011 . www.medtronic.com >covidien > fixation .
![Page 38: Anatomy & technique of the laparoscopic totally extra peritoneal](https://reader036.vdocument.in/reader036/viewer/2022062310/58f9b11c760da3da068bbd78/html5/thumbnails/38.jpg)
38
THANK YOU…