LAPAROSCOPIC INGUINAL HERNIA SURGERY IS IT NECESSARY, IS IT ADVANTAGEOUS? Asoc. Prof.Dr. Orhan Yalçın Ministry of Health Okmeydanı Education and Research Hospital İstanbul / Turkey

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After a few years, laparoscopic cholecystectomy has become gold standard operation for cholelithiasis. But laparoscopic inguinal hernia surgery has not became gold standard yet. And in general it is not procedure of choice now. 3

IS IT ADVANTAGEOUS? -Laparoscopic herniorraphy has some advantages. - In randomize studies, it has shorter hospital stay than open operation. -It has lower incidence of persistent pain and numbness. -In recurrent hernia, it allows you to work in an undisturbed area. -The mesh covers all myopectineal orifice including potential femoral hernia area. 4

IN WHICH CASES LAPAROSCOPY IS ADVANTAGEOUS ESPECIALLY ? -Recurrent hernia after open repair : Open repair is usually done with anterior approach, retro peritoneal area is unscarred and easier to operate. -Bilateral Inguinal Hernia : It allows from one incision, to reach bilateral hernia area. It saves time. - If a patient, who requires any clean laparoscopic surgery at the same time (i.e. gynecological operation) In a patient who has an unilateral hernia but a contra lateral hernia is strongly suspected. - Laparoscopy allows to control and if there is another hernia to treat it. - In a patient who has coincidental femoral hernia. 5

DISADVANTAGES -It needs general anesthesia -Lower cost effectiveness. -Requires general anesthesia -It requires some equipments. In repair some reusable tracers and graspers can be used. - Learning curve is long. Maybe need cases -Rare but major complication risk is higher Bowel injury, nerve injury, arterial –venous injury. 6

OUR CLINIC EXPERIENCE WITH TEP BETWEEN 2006 – patients -375 operations -Recurrence = 4 ( 1,07 % ) -Mean follow up = 31 months 7

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