الفهرس 
LAPAROSCOPIC ANATOMY OF THE INGUINAL REGIONOnly 14 pages are availabe for public view
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Abstract
Hernia (in Latin, the rupture of a portion of a structure) is defined as a protrusion of the normal internal abdominal viscera through a weakness or defect in the fascial and muscular layers which normally confine them. The groin region, lying between the lower abdomen and the thigh, represents one of the weakest natural points of the abdominal wall and is the site of most common abdominal wall hernias
Inguinal hernia repair is one of the most common surgical procedures. Over the past 20 years, several hernia repair techniques have been introduced. The main course for the development of these new techniques was to reduce the recurrence rate. After the introduction of laparoscopic inguinal hernia repair, most of the discussions have focused on the choice between open or laparoscopic surgery.
Laparoscopic inguinal herniorrhaphy is associated with shorter recovery periods, earlier return to daily activities and work, and decreased postoperative pain. Some surgeons think that laparoscopic repair of recurrent hernia is easier because it is performed in a virgin tissue. Laparoscopic approach has also advantages over open techniques for bilateral hernias. On the other hand laparoscopic hernia repair has a significant learning curve.
No disease of the human body belonging to the province of the surgeon requires in its treatment a greater combination of accurate anatomic knowledge with surgical skill than hernia in all its varieties.The anatomy of the inguinal region is misunderstood by some surgeons at all levels of seniority.
For a safe and successful approach to the laparoscopic herniorraphy, the anatomy should be visualized from inner layers, since laparoscopy provides an optimal panoramic view of the posterior surface of the abdominal wall. It also requires good viewing angle, proper direction of lighting and empty bladder.
The two most common laparoscopic hernia repairs now are the transabdominal preperitoneal repair (TAPP) and the total extraperitoneal repair (TEP). Other laparoscopic techniques, such as closure of the internal ring, ring plasty, placement of a mesh plug and patch, and the intraperitoneal onlay of mesh (IPOM) have largely been abandoned, at least in America and Europe. Both the TAPP and TEP have the same basic principle of placing a piece of mesh in the preperitoneal space as described by Stoppa.
Laparoscopic herniorrhaphy shares some complications with the open technique but also has its own set of complications. Some of these problems were encountered early on and were corrected as surgeons became more experienced with the technique. Thus, the incidence of complications has decreased with time
Complications in endoscopic inguinal hernia surgery are more dangerous and more frequent than those of open surgery, especially in inexperienced hands and hence are best avoided. It is possible to avoid most of these complications if one follows a set of well-defined steps and principles of endoscopic inguinal hernia surgery
Complications are known to occur at each and every step of hernia surgery. Applying caution while performing each step can save the patient from a lot of morbidity. One starts by applying strict patient selection criteria for endoscopic hernia repair, especially in the initial part of ones learning curve. A thorough knowledge of anatomy goes a long way in avoiding most of the complications seen in hernia repair. This anatomy needs to be relearned from what one is used to, as the approach is totally different from an open hernia repair. And finally, learning and mastering the right technique is an essential prerequisite before one ventures into inguinal hernia repair. Although there has been an increased incidence of complications reported in endoscopic repair in the earlier series, this can be explained partly by the fact that it was in the early part of the learning curve of most endoscopic surgeons. As the experience grew and the techniques were standardized, the incidences of complications have also reduced and have come to be on par with open hernia surgery.