TAPP REPAIR FOR INGUINAL HERNIA - DR. SANKPAL'S REPAIR Presenting Author : DR. JITENDRA T. SANKPAL MS (MUM) FICS FIAGES Prof. & H.O.D. Co-authors : Dr. S.V. Daga, Dr. Shriniketan Kale, Dr. S.N.Bamne, Dr. Shweta Shende Dept. of General & G.I. Lap. Surgery Dr. V.M. Govt. Medical College, Solapur.

Dr. V.M.Govt.Medical College, Solapur.

Demography JAN—DEC 2006 Total no. of cases - 50 Total no. of hernioplasties - 54 Unilateral cases 46 (indirect 40 , direct 6 ) Bilateral cases 4 (indirect 4 , direct 4 ) Anaesthesia GA 24 Cases SA 26 cases

PORT SITES . 10 mm umbilical - Telescope 00  PORT SITES  10 mm umbilical - Telescope 00  10 mm lateral and at level of umbilicus on side of hernia  5 mm lateral and below umbilicus on side opposite to hernia.  No RT insertion or Urinary catheter  Peri-operative 1 gm injection cefotaxime IV.

PORT POSITION Surgeon Assistant 5mm Camera 10 mm Monitor

OBSERVATION Mean operative time (min.) Mean hospital stay - 33.6 hours

Analgesic requirement Pain score not measured but 90 % of patients didn’t required analgesic beyond 48 hours. Return to activity of daily living : Home activities - 3 to 5 days Work activities - 5 to 7 days

OBSERVATION Complication - Port site infection in. - OBSERVATION Complication - Port site infection in - Three patient Urinary retention - Nil Bleeding - Nil Chronic pain / Neuralgia - Nil Heamatoma - Nil Scrotal seroma - Three patient Testicular pain / swelling - Nil Hydrocoele - Nil Enterotomy - Nil Bladder injury - Nil Intestinal obstruction - Nil

Conversion to open - Nil - Mean follow up was 12 months - No recurrence

RECURRENCE RATE : Schultz et al (1994) Recurrence mainly associated with placement of sufficient sized prosthesis (10cm x 15cm )

CONCLUSION . Simple, cost effective, time saving.  CONCLUSION  Simple, cost effective, time saving.  Steps prone for complications are avoided  More reliable repair for beginners  Irreducible obstructed hernia can be manage.  CO2 absorption is less than in TEP repair.  Procedure of choice for patients with lower abdominal incision.  Unexpected contra lateral hernia can be managed.  Diagnostic peritoneoscopy is possible  Simultaneous appendicectomy, adhesiolysis cholecystectomy etc. feasible.

IT’S MY SAFE, SIMPLE, COST EFFECTIVE & INNOVATIVE REPAIR TO PASS ON BENEFITS OF LAPAROSCOPIC SURGERY TO HERNIA PATIENTS, INSPITE OF NON AVAILABILITY OF SOPHASTICATED INSTRUMENTS AND COSTLY TUCKERS.

Thank You