Lower abdominal scars are a common site for developing incisional hernias. The complex anatomy of the pelvic and lower abdomen limits the size of Intraperitoneal placement of large preperitoneal mesh in such situations help in overcoming this problem.
Methods: From Jan 2006 to June 2009, we performed TAPP procedure in 15 patients, of which 13 were female and 2 were male. Pffanensteil scar accounted for 12 of those patients and there were 10 lateral and 5 supralpubic defects. Mean age of the patients is 46 years. All patients were catheterised before the procedure. The patient is placed supine, the team set up and ports placement are the same as in inguinal hernia repair. The dissection commenced by raising the peritoneal flap superior to the defect. Sac Is reduced and the space Is dissected up to Anterior Superior Iliac Spine laterally and the retzius space medially. Special care is taken care not to make hole In the peritoneum while dissection, especially at the scar area. The defect Is then closed Intracorporeally using 1 loop Polyamide which is fixed subcutaneously. Polypropelene mesh which overlaps altleast 5 cms on all sides Is placed In the space and fixed to cooper,s ligament and at rectus mucsle. The peritoneal flaps are closed with intracorporeal sutures. Mean operating time is 65 minutes and the hospital stay is 1.5 Days. 2 patients developed seroma, one requiring aspiration. With a mean followup of 15 months, there is no recurrence in our series
Conclusion: Laparoscopic TAPP approach is a good option for lower abdominal incisional hernias and obviates the need for intraperitoneal mesh placement and permitting large mesh to be kept in a small area.
Program Number: P466