Laparoscopic TAPP for bilateral inguinal hernia
Epublication WebSurg.com, Sep 2007;07(09). URL: http://websurg.com/doi/vd01en2173
This video, recorded live during a surgical course, demonstrates the TAPP approach to bilateral hernia repair. Dr. Joel Leroy performs the repair using two separate meshes, one side at a time. This procedure is recommended to a general surgical audience. The author uses a 3-trocar approach with a 0-degree 10mm optical scope. Exploration reveals some vivid landmarks, including abdominal wall adhesions from a previous appendectomy. The midline of the urinary bladder, umbilical ligament, vas deferens duct crossing behind the umbilical artery from behind —a key landmark the author will use during dissection of the peritoneum — and spermatic vessels all come into view. The direct hernia is visible between the epigastric vessels, retracted medially, and the umbilical ligament, retracted into the sac. When the author tries to reduce the sac, pressure pushes it back.