Approach to Hernia TAPP Lecture by Dr. R.K. Mishra

Introduction: Transabdominal preperitoneal (TAPP) repair is a minimally invasive surgical technique used to treat inguinal hernias. The TAPP approach involves the placement of a laparoscope through a small incision in the abdominal wall, allowing the surgeon to view and repair the hernia from the inside of the abdominal cavity. This technique offers many advantages over traditional open surgery, including reduced pain, shorter hospital stays, and faster recovery times.

Preoperative Evaluation: The first step in the TAPP approach to hernia repair is a thorough preoperative evaluation. This evaluation includes a detailed medical history, physical examination, and diagnostic imaging, such as ultrasound or CT scan, to confirm the presence of a hernia and to assess its size and location.

The patient's medical history should include any previous surgeries, medical conditions, and medications that may increase the risk of complications during the TAPP procedure. The physical examination should assess the extent of the hernia and any associated symptoms, such as pain or discomfort.

Anesthesia and Patient Positioning: TAPP hernia repair is typically performed under general anesthesia. Once the patient is anesthetized, they are placed in the supine position with their arms tucked at their sides. The surgeon may also place a foam pad under the patient's hips to provide additional support and improve exposure of the operative field.

Creation of the Pneumoperitoneum: The TAPP approach requires the creation of a pneumoperitoneum, which is achieved by insufflating the abdominal cavity with carbon dioxide gas. This creates a working space for the surgeon and allows for improved visualization of the hernia.

To create the pneumoperitoneum, the surgeon first inserts a Veress needle or a trocar into the abdominal cavity. Carbon dioxide gas is then delivered through the needle or trocar to inflate the abdominal cavity to a pressure of 12-15 mmHg.

Placement of the Trocars: After creating the pneumoperitoneum, the surgeon will place several trocars in the abdomen. These trocars serve as portals for the laparoscope and surgical instruments. Typically, three trocars are used for TAPP hernia repair: one for the laparoscope and two for surgical instruments.

The laparoscope is inserted through the first trocar, which is placed in the umbilicus. The other two trocars are placed in the lower abdomen, one on either side of the hernia defect.

Reduction of the Hernia: Once the trocars are in place, the surgeon will use the laparoscope to view the hernia and surrounding tissue. The hernia sac is then carefully dissected away from surrounding structures, and the contents of the hernia are reduced back into the abdominal cavity.

Mesh Placement: After the hernia is reduced, the surgeon will place a mesh over the hernia defect to reinforce the abdominal wall and prevent recurrence of the hernia. The mesh is typically made of a synthetic material and is secured in place using absorbable tacks or sutures.

Closure of the Abdominal Wall: Once the mesh is in place, the surgeon will remove the trocars and close the incisions in the abdominal wall. The skin incisions are typically closed with absorbable sutures or surgical glue.

Conclusion: In conclusion, the TAPP approach to hernia repair is a safe and effective surgical technique that offers many advantages over traditional open surgery. The key steps of the TAPP procedure include preoperative evaluation, creation of the pneumoperitoneum, placement of trocars, reduction of the hernia, mesh placement, and closure of the abdominal wall. With proper technique and patient selection