Transabdominal Preperitoneal (TAPP) Hernia Repair

The Transabdominal Preperitoneal (TAPP) technique is a minimally invasive method that offers a quicker recovery and less pain than traditional hernia surgeries. This guide breaks down the TAPP procedure into understandable parts.

What is TAPP?

The TAPP technique repairs inguinal hernias using small incisions, cameras, and a mesh. It’s done by accessing the hernia from inside the abdomen but placing the mesh in the preperitoneal space (the area between the abdominal wall and the peritoneal lining).

The TAPP Hernia Repair Technique Procedure Steps

 

1. Preparation and Access: Surgeons begin by inflating the abdomen with gas (pneumoperitoneum) to create space for the operation. This is done through small cuts (incisions), where ports (thin tubes) are inserted for tools and a camera.
2. Incision and Exposure: A cut is made in the peritoneum (the lining of the abdominal cavity) to reach the preperitoneal space. This exposes the hernia and surrounding tissues.
3. Dissection and Hernia Reduction: The area around the hernia is carefully separated, and the hernia itself is pushed back into the abdomen.
4. Mesh Placement A synthetic mesh is placed over the hernia opening in the preperitoneal space. This mesh strengthens the area, preventing the hernia from recurring.
5. Securing the Mesh: The mesh may be secured with stitches, staples, or glue. Some methods avoid securing the mesh to reduce pain without increasing the risk of the hernia coming back.
6. Closing the Incision: The initial cut in the peritoneum is stitched or stapled shut, covering the mesh.
7. Finishing Up: The tools and ports are removed, and the small incisions are closed, often with stitches that dissolve over time.

Benefits of TAPP Hernia Repair

• Minimally Invasive: The TAPP approach results in less bodily disruption than traditional open surgery, leading to smaller scars and often more satisfying aesthetic outcomes.
• Reduced Pain Post-Surgery: Generally, patients report experiencing less discomfort following the TAPP procedure when compared to the aftermath of conventional open hernia repairs.
• Quicker Recovery Time: This method facilitates a faster healing process, enabling patients to resume their normal activities and return to work sooner.
• Low Recurrence Rates: Proper execution of the TAPP procedure is associated with a low risk of hernia recurrence, making it a reliable option for long-term repair.
• Capability for Bilateral Repair: TAPP is efficiently used for repairing hernias on both sides of the groin during the same operation, reducing overall patient trauma and recovery time.
• Opportunity for Intra-Abdominal Examination: The approach grants surgeons the ability to inspect the abdominal cavity for other potential issues, which can then be addressed simultaneously.

Limitations of TAPP Hernia Repair

• Technical Demands: The success of the TAPP method hinges on the surgeon’s expertise, especially in terms of mesh handling and placement.
• Risk of Injury to Internal Organs: The nature of this procedure, which involves navigating the abdominal cavity, carries a risk of accidental damage to internal organs.
• Postoperative Complications: Although infrequent, complications such as bowel obstruction, mesh migration, and chronic pain can occur, necessitating careful postoperative monitoring.
• Higher Costs: The requirement for specialized equipment and materials, including the use of robotic assistance for some surgeries, may render the TAPP procedure more costly than traditional methods.

Considerations for Mesh Use

• Mesh Type: The choice of mesh, typically polypropylene due to its durability, biocompatibility, and cost-effectiveness, plays a critical role in the outcome of the surgery. The decision between using synthetic or biological meshes can influence factors like chronic discomfort and the chance of hernia recurrence.

In summary, the TAPP hernia repair technique presents a significant advancement over conventional open surgeries, offering benefits such as diminished postoperative pain and expedited recovery. Nonetheless, it demands specialized skills from the surgeon and carries its own set of risks that must be carefully weighed. The selection of mesh material further influences the surgical outcome, underscoring the importance of tailored surgical planning.

Laparoscopic vs. Robotic TAPP

The steps for both laparoscopic (using special tools and a camera) and robotic TAPP (using a robot the surgeon controls) are similar. The main difference is the use of a robotic system in the latter, which may enhance precision and control.

Why Will a Hernia Surgeon Choose TAPP?

TAPP is less invasive than traditional surgery, leading to:

• Less postoperative pain
• Faster return to normal activities
• Lower risk of the hernia returning

What Types of Hernias are Suitable for TAPP?

Inguinal Hernias: These are hernias near the groin. TAPP is great here because it lets doctors place a special kind of patch (mesh) in just the right spot to cover the hernia.

Femoral Hernias: Similar to inguinal hernias but in a slightly different area, TAPP can also tackle these effectively.

Incisional Hernias (sometimes): If you’ve had surgery before and get a hernia at the scar site, TAPP might be an option, especially for smaller ones in the lower belly.

Hernia Types Not Typically Ideal for TAPP

Big or Complicated Hernias in the Belly Wall: If the hernia is really big or tricky, doctors might go for a different method that involves more detailed work.

Hiatal Hernias: These occur near the diaphragm (the muscle that helps you breathe) and need a different fix.

Umbilical Hernias: These are at the belly button and don’t fit the TAPP approach, but there are other laparoscopic (small incision surgery) methods that might work.

Understanding Your Options: TAPP vs. TEP

When it comes to repairing inguinal hernias with a minimally invasive approach, patients and surgeons often choose between two primary techniques: Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP) repair. Both methods have their unique advantages and considerations. Understanding the differences can help in making an informed decision tailored to individual needs.

TAPP (Transabdominal Preperitoneal) Repair

TAPP involves entering the abdominal cavity to place a mesh in the preperitoneal space, effectively reinforcing the weakened area. This approach allows the surgeon to have a broad view of the abdominal cavity, potentially identifying and addressing other abdominal issues if present. It is versatile and can be used for almost all types of inguinal hernias, including those that are recurrent or complicated by previous surgeries.

Advantages of TAPP:

• Comprehensive view of the abdominal cavity.
• Ability to handle complex and recurrent hernias.
• Familiar approach for surgeons experienced in laparoscopic procedures.

TEP (Totally Extraperitoneal) Repair

TEP, on the other hand, avoids entering the abdominal cavity altogether. The procedure is conducted entirely in the preperitoneal space, directly addressing the hernia without the potential complications associated with abdominal cavity access, such as injury to the intestines or other intra-abdominal organs.

Advantages of TEP:

• Reduced risk of complications related to abdominal cavity entry.
• Potentially shorter recovery time due to less invasive nature.
• Lower risk of developing adhesions, which are bands of scar tissue that can cause organs to stick together.

Choosing Between TAPP and TEP

The choice between TAPP and TEP is influenced by several factors, including:

• Surgeon’s Expertise and Preference: Some surgeons may prefer one technique over the other based on their training, experience, and the outcomes they’ve observed in their practice.
• Patient’s Medical History: Patients with previous abdominal surgeries may benefit more from a TEP repair to avoid potential adhesions in the abdominal cavity. Conversely, TAPP might be more suitable for identifying and addressing concurrent abdominal issues.
• Hernia Characteristics: The size, location, and whether the hernia is a recurrence can influence the choice of technique. TAPP might be preferred for complex or recurrent hernias due to the broader view it provides.
• Patient’s Lifestyle and Recovery Goals: Recovery times and post-operative pain can vary slightly between the two techniques, influencing patient preference based on their lifestyle and how quickly they wish to return to normal activities.

Dr. Iskandar’s Remarks on TAPP

This is an excellent minimally invasive repair. For women specifically, minimally invasive surgery is recommended as it allows mesh coverage of all potential hernia defects (indirect, direct, femoral, and obturator) as women have a higher chance of femoral and obturator hernias

Conclusion

In conclusion, the Transabdominal Preperitoneal (TAPP) hernia repair technique stands out as a minimally invasive option that offers numerous benefits, including reduced recovery time and lower risk of complications. It’s particularly effective for repairing inguinal and femoral hernias, making it a versatile choice for many patients. While it may not be suitable for all types of hernias, its ability to allow surgeons to place mesh in the preperitoneal space accurately makes it an invaluable option in the surgical toolbox. The decision to use TAPP over other methods depends on various factors, including the specific characteristics of the hernia and the surgeon’s expertise, highlighting the importance of a tailored approach to hernia repair.

See all the hernia repair techniques library.

 

source https://iskandarcenter.com/hernia-surgery/transabdominal-preperitoneal-tapp-hernia-repair/