الفهرس 
Introduction
Anatomy of inguinofemoral AreaOnly 14 pages are availabe for public view
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Abstract
Surgical repair of inguinal hernia is considered the only definitive management of hernia. The outcome of hernia surgery is operator dependent, as hernia repair, requires the combination of anatomical knowledge of the details of the inguinal area and advanced skills to deal with different varieties of hernia presentation.
Inguinal hernia repair is the most common general surgical procedure in the world. More than 800,000 hernia repair has been done annually in the USA, 10% for recurrent hernias, and 15% of cases underwent laparoscopic repair.
The main causes of inguinal hernia can be either patient dependent like tissue collagen structure affection and inherited diseases, or acquired causes that leads to increase intra-abdominal pressure.
Tissue repair was the treatment of choice one hundred years ago, with emerging different procedures to fix and support the inguinal canal wall. However, the tension resulted from this repair leads to a higher recurrence rate and more postoperative pain.
Tensionless repair with using prosthetic material was the solution for this problem, with less pain and low recurrence rate, Lichtenstein repair became the standard for hernioplasty, which most studies used to compare it with the new technique.
In 1990 the first laparoscopic repair started by the plug, but results were disappointing. Laparoscopic repair with placing the mesh preperitoneal either through the abdominal cavity (TAPP) or totally extraperitoneal (TEP)
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Summary
were the two main laparoscopic repair, but the long learning curve discourages surgeon to switch hernia repair into laparoscopic procedure, however, it is the recommended procedure in recurrent and bilateral hernia where it was superior to open approach.
In this trial comparing TAPP with new modification of the TAPP approach by using CO2 gas as a dissector in preperitoneal space to revealed if this makes difference as regard time and clarity of the operative field and hence postoperative outcome. These two groups were also compared with open Lichtenstein repair.
The results showed no significant difference between groups in sociodemographic data (age, BMI, type of job, and smoking). And there is no statistically significant difference between the groups in the form of hernia characters like side, type and duration in months.
As regard the operative data; time and complication, there was a statistically significant difference in operative time between the open repair from one side and the two laparoscopic groups from the other side. However between the two laparoscopic groups, there was no statistically significant difference in operative time. There was a difference in difficulty assessment of the procedure for the dual approach (group III) in lateral and medial side dissection but not the sac.
As regards the operator, there was a statistically significant difference in operative time between the experienced surgeon and the less experienced one.
Regarding the post-operative pain and complications, there was no statistically significant difference between the three groups.
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