https://www.laparoscopyhospital.com/SERV01.HTM<br /><br />Laparoscopic Transabdominal Preperitoneal (TAPP) hernia repair has revolutionized the management of inguinal hernias, offering a minimally invasive alternative with excellent clinical outcomes. Among the techniques employed during TAPP, the suturing method for mesh fixation and peritoneal closure is gaining attention due to its cost-effectiveness, reduced foreign material implantation, and potential for better anatomical restoration. This article explores the critical steps, advantages, and technical nuances of performing TAPP hernia repair by suturing.<br /><br />Overview of TAPP Hernia Repair<br />TAPP hernia repair involves gaining access to the preperitoneal space through a transabdominal approach, reducing the hernia sac, and placing a prosthetic mesh to reinforce the myopectineal orifice. The peritoneum is then closed to prevent adhesion formation between the mesh and intra-abdominal organs. Suturing, as opposed to using tackers or glues, offers several benefits:<br /><br />Reduced Foreign Material: Avoids the use of non-absorbable tackers, minimizing chronic pain and foreign body reaction.<br />Cost-Efficiency: Eliminates the need for expensive fixation devices.<br />Secure Fixation: Allows tailored and robust closure, especially in challenging anatomy.<br />Key Steps in TAPP Hernia Repair by Suturing<br />1. Patient Positioning and Port Placement<br />The patient is positioned in the Trendelenburg position to facilitate bowel displacement.<br />A standard three-port technique is employed:<br />A 10-mm supraumbilical port for the laparoscope.<br />Two 5-mm working ports, typically in the midclavicular line on either side.<br />2. Creation of the Preperitoneal Space<br />A peritoneal incision is made 4–5 cm above the hernia defect.<br />Dissection is carried out to expose the hernia sac and critical structures such as the vas deferens, spermatic vessels, and Cooper’s ligament.<br />The hernia sac is carefully reduced, ensuring no residual content remains.<br />3. Mesh Placement<br />A pre-sized polypropylene or composite mesh (15 cm x 12 cm) is introduced into the preperitoneal space.<br />The mesh is positioned to overlap the defect by at least 3 cm in all directions, ensuring adequate coverage.<br />4. Mesh Fixation by Suturing<br />Suturing is performed using non-absorbable or slowly absorbable sutures (e.g., 2-0 or 3-0 barbed sutures or monofilament sutures).
