OV03 TEP IN COLORS: ANATOMICAL VIEW USING ARTICULATED FORCEPS

Aim Present through an illustrative and educational video, an anatomical and colorful vision of the totally extraperitoneal laparoscopic approach (TEP) of inguinofemoral hernias, with the aim of favoring the learning process of this technique, facilitating the identification of the main anatomical structures, ensuring a safe and effective approach. Material and Methods In this video we show the laparoscopic approach to inguinofemoral hernias via TEP, highlighting the most important anatomical structures with different colors. Additionally, the surgical technique of this approach using articulated forceps is shown, which we consider to be a good resource for dissection in a space as small as the preperitoneal one. Results The anatomical study of the inguinofemoral area constitutes the basis of a correct preperitoneal approach, especially in PET, where the most difficult is probably the space location and the identification of the structures. Conclusions The preperitoneal PET route is a relatively novel approach for inguinofemoral hernia repair. Its benefits are based on the ability to identify all the anatomical structures of the myopectineal orifice from a preperitoneal view without the need to access the peritoneal cavity. The knowledge of preperitoneal anatomy is the cornerstone for learning the TEP approach, and we consider that anatomical videos of real surgeries are good strategies to shorten the learning curve. Mastering the preperitoneal anatomy ensures obtaining the benefits inherent to the TEP approach, such as bilateral exploration of the myopectineal orifice, direct visualization of the pain and doom triangles, tension-free repair with mesh of all possible defects and faster postoperative recovery.

A comparative study of Lichtenstein tension free hernioplasty with prolene hernia system hernioplasty for ingunial hernia

Background: Lichtenstein tension-free hernioplasty (LTH) has become the gold standard for hernia repair. It is easy to learn and perform with minimal complications and low recurrence rate. But it deals with only superior half of the myopectineal orifice. Prolene hernia system (PHS) hernioplasty is safe, causes minimal pain and has minimal recurrence rate but is still not popular due to high cost. The aim of the study is to compare the Lichtenstein tension-free hernioplasty with hernioplasty using prolene hernia system.Methods: A total of 60 patients with inguinal hernia were equally grouped into cases (PHS) and controls (LTH). Outcome measures were compared with regards to postoperative pain, hospital stay and complications.Results: There was no significant difference in mean days of post-operative hospital stay among cases and controls. On post-operative days 1 and 3, most of the patients experienced moderate pain and by 8th post-operative day most of the patients had no pain. The pain intensity decreased with increase in post-operative days. Seroma formation was seen among 2 (6.67%) cases (PHS) group in comparison to 3 (10.0%) controls (Lichtenstein) group. Post-operative wound infection was seen among 1 (3.33%) cases (PHS) group and controls (Lichtenstein) group each. Recurrence was seen neither among patients treated with either technique.Conclusions: Prolene Hernia System mesh repair could be a suitable alternative to time honored Lichtenstein hernia repair with added advantage of strengthening the whole of myopectineal orifice, and virtually eliminating any risk of recurrence.