الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
 |  | from | 161 |  |  |
| | | from | 161 | | |
Abstract
The treatment of Huge inguinal hernia will continue to be a significant
part of many surgeons day to-day-workload .And also undergo technical
modifications. The introduction of minimally invasive surgery had added
a possible new dimension.
In conclusion, the present technique provides good solutions for:
l-the problem of limited abdominal cavity by increasing the interaabdominal
capacity to accommodate the replaced hernial contents by
used transverse incision in open surgery group..
2-Simulataneous hernia repair and covering of the created anterior
abdominal wall defect by insertion of a giant mesh in the preperitoneal
space.
3-Prevention of adhesion and fistula formation that may result from
direct contact between the mesh and the intestine by the use of the hernia
sac, that would otherwise be discarded, to cover the intestine
(reperitonalization beneath the mesh).
4-the three dimensional Laparoscopic anatomy of the inguinal region
must be positively identified by the surgeon in order to avoid injury of
important structures.
5-complications of open classic hernia repair which can be avoided or
minimized by laparoscopic repair are :severance of testicular blood
supply,vas defemse,nerves,injury to the bowel, wound complications and
hernia recurrence .
As a trial to solve the problem of the difficult surgical exposure of
the huge inguinal hernia which is liable for injury of important structures
within the inguinal canal ,namely the vasdeferens .testicular artery ,
pampinifonn plexus of veins and nerves due to adhesions and to solve
the problem of great liability of recurrence because th.e weakness of
abdominal musculature ,this comparative study was clone on twenty
cases of Huge inguinal hernia.
Our study was done on twenty cases of huge inguinal hernia ;
Patients were divided into two main groups (1) and (11) each include 10
patients for group (1) Suprapubic transverse (Pfannenstils) incision
.For group (11) Transabdominal Preperitoneal Laparoscopic
Herniorraphy (T APP). Postoperative pain ,seroma ,hematoma and
scrotal edema ,wound infection, ecchemosis ,average drainage fluid and
time of removal of the drain were less in group (1) than in group (11),
but the dyspnea ,pneump-peritoneum and pneumo-scrotum in the (11)
group.
It was concluded that the of polypropylene mesh is the recommended
prosthesis in preperitoneal hernioplasty unless ther is a that prosthesis
may be exposed to bowel where PTFE mesh may be the material of
choice.
The preperiteneal approach with polypropylene mesh reinforcement the
visceral sac has the benefits of being easy ,rapid and safe procedure for
the treatment of Huge inguinal hernia .
The Laparoscopic repair is best suited to the patients in good general
health who cannot afford an extended time away from work.
We believe the operation has a place in the modern management of
inguinal hernias though continued assessment of the procedure is
essential to determine long-term recurrence rates.
Our new modification for treatment of huge inguinal hernia are
summarized as follow :
1) I used suprapubic transverse (Pfannenstils) incision and I used (pPM
mesh) polyprolin mesh instead of subumblical incision used by Stoppa
technique and Gortex mesh .
2) Mesh fixed preperitoneal approach through the transverse incision so
complications related to adhesions, erosion of the patch material into the
viscera, bowel obstruction, or fistula formation did not OCI;ur.
3)The open technique is suitable for huge irreducible hernias more than
Laparoscopic technique .
4) We used Laparoscopic transabdominal preperitoneal repair for huge
inguinal hernia ,mainly reducible not strangulated.
5)The best suitable for Laparoscopic repair .patients in good general
health who cannot afford an extended time away from work.
6)The older patients with pre-existing cardiopulmonary disease and
complicated hernia should still be managed in the conventual’s way.
We hope that by adding an endoscopic alternative to the general
surgeons options ,the early result are promising ,though long term
follow-up is not yet available. We believe the operation has a place in
the modern management of inguinal hernias though continued
assessment of the procedure is essential to determine long-term
recurrence rates.
The Laparoscopic repair form of treatment appears to represent a new
approach to solve an old problem.