https://www.laparoscopyhospital.com/SERV01.HTM<br /><br />Laparoscopic repair of bilateral inguinal hernia is a minimally invasive technique that has gained popularity due to its benefits over open surgery, such as reduced postoperative pain, quicker recovery, and better cosmetic results. The use of ipsilateral ports, where all ports are placed on one side of the abdomen, offers a novel approach to this procedure. This article discusses the methodology, benefits, and considerations of performing laparoscopic repair of bilateral inguinal hernia using ipsilateral port placement.<br /><br />Anatomy and Pathophysiology<br />Inguinal hernias occur when abdominal contents protrude through a weak spot in the inguinal canal. This can happen on one or both sides (bilateral). The laparoscopic approach allows for a thorough examination and repair of both hernias through small incisions, reducing tissue trauma and promoting faster healing.<br /><br />Preoperative Considerations<br />Patient Selection: Ideal candidates include those with bilateral inguinal hernias, good overall health, and no contraindications for laparoscopic surgery (e.g., severe cardiopulmonary disease).<br />Anesthesia: General anesthesia is typically required.<br />Preparation: Standard preoperative preparations, including fasting and bowel preparation, should be followed. Prophylactic antibiotics may be administered.<br />Surgical Technique<br />Patient Positioning: The patient is placed in a supine position with slight Trendelenburg tilt to allow the intestines to fall away from the inguinal region.<br />Port Placement:<br />Ipsilateral Port Configuration: Three ports are usually sufficient. A supraumbilical or periumbilical port is used for the camera, and two working ports are placed on the ipsilateral side, typically in the midclavicular and anterior axillary lines. This configuration allows for adequate triangulation and access to both inguinal regions.<br />Pneumoperitoneum: The abdominal cavity is insufflated with CO2 to create a working space.<br />Dissection: The peritoneum over the hernia defects is incised, and the hernia sacs are reduced. Care is taken to avoid injury to the inferior epigastric vessels and the vas deferens in males.<br />Mesh Placement: A large piece of polypropylene mesh is placed to cover the myopectineal orifice on both sides. The mesh is secured with tacks or sutures.<br />Peritoneal Closure: The peritoneum is closed over the mesh to prevent bowel adhesions.<br />Postoperative Care<br />Recovery: Patients are monitored in the recovery room until they are stable. Pain management is usually achieved with NSAIDs and acetaminophen. Narcotics are rarely needed.<br />Activity: Early ambulation is encouraged to reduce the risk of thromboembolic events. Patients are advised to avoid heavy lifting for at least four weeks.
