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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.
Overview of TAPP Hernia Repair
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:
Reduced Foreign Material: Avoids the use of non-absorbable tackers, minimizing chronic pain and foreign body reaction.
Cost-Efficiency: Eliminates the need for expensive fixation devices.
Secure Fixation: Allows tailored and robust closure, especially in challenging anatomy.
Key Steps in TAPP Hernia Repair by Suturing
1. Patient Positioning and Port Placement
The patient is positioned in the Trendelenburg position to facilitate bowel displacement.
A standard three-port technique is employed:
A 10-mm supraumbilical port for the laparoscope.
Two 5-mm working ports, typically in the midclavicular line on either side.
2. Creation of the Preperitoneal Space
A peritoneal incision is made 4–5 cm above the hernia defect.
Dissection is carried out to expose the hernia sac and critical structures such as the vas deferens, spermatic vessels, and Cooper’s ligament.
The hernia sac is carefully reduced, ensuring no residual content remains.
3. Mesh Placement
A pre-sized polypropylene or composite mesh (15 cm x 12 cm) is introduced into the preperitoneal space.
The mesh is positioned to overlap the defect by at least 3 cm in all directions, ensuring adequate coverage.
4. Mesh Fixation by Suturing
Suturing is performed using non-absorbable or slowly absorbable sutures (e.g., 2-0 or 3-0 barbed sutures or monofilament sutures).
