Laparoscopic Hernia Repair
Web-site of Laparoscopic surgery
surgeon: Mark Pleatman, MD
Laparoscopic Hernia Repair
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Pertinent anatomy in a thin male with a left indirect inguinal hernia
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Dissection starts with opening the peritoneum lateral to the medial umbilical fold in order to identify Cooper's ligament
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Cooper's ligament has been exposed from the pubic tubercle down to the femoral vessels and the vas deferens
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The ileopubic tract lateral to the internal ring is exposed. It is critical to avoid dissection or stapling posterior to this line in order to avoid injury to cutaneous nerves.
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The dissection is complete. The indirect sac is left in place.
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An 8 by 12 cm. GoreTex dual-mesh patch is now inserted. I use this material because it is resistant to adhesions, and can be placed without need for reperitonealization.
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The mesh has been stapled from the pubic tubercle along Cooper's ligament down to the femoral vessels. It is now being stretched across laterally and stapled to the ileopubic tract.
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The patch is then flipped up anteriorly, covering the hernia defect(s). It is stapled to the abdominal wall circumferentially. This completes the repair. This is the repair first devised by Fred Toy and Roy Smoot, and has been studied by a multi-center group in more than 500 patients. Recurrence rate over several years is 4%.
