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Chapter 27: Abdominal Wall and Retroperitoneum

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Which of the following is true regarding laparoscopic inguinal hernia repair?

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(A) There are three primary approaches.

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(B) The extraperitoneal approach has a higher rate of recurrence.

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(C) The abdominal approach makes use of a dissection balloon.

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(D) Pain levels on postoperative day 1 are increased compared to open hernia repair.

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(E) The extraperitoneal approach dissects between the peritoneum and transversalis fascia.

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(E) Laparoscopic inguinal hernia repair is a procedure that has been in common practice for over 10 years. The two most commonly performed types are the transabdominal preperitoneal (TAPP) and the totally extraperitoneal (TEP) approaches. The TAPP involves laparoscopic dissection of the peritoneum off of the pelvic floor and hernia sac, placement of mesh around the defect, and closure of the peritoneum over the mesh. The TEP involves dissection between the peritoneum and transversalis fascia with a dissecting balloon, with subsequent creation of a pneumoextraperitoneum to allow visualization, reduction of the hernia, and placement of mesh.

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Regardless of the technique used, there are several contraindications to the laparoscopic technique. Of, course the patient must be able to hemodynamically tolerate both general anesthesia and the effects of pneumoperitoneum as with any laparoscopic surgery.

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Previous preperitoneal surgery, history of radical prostatectomy, strangulation of the hernia, infection, and history of pelvic radiation secondary to the presence of scarred tissue in the preperitoneal space are contraindications to laparoscopic repair. Cirrhosis with portal hypertension and ascites is considered only a relative contraindication to laparoscopic repair.

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Recurrence rate for both techniques range from 0 to 5%, and patients who undergo laparoscopic hernia repair experience less pain in the early postoperative period and have lower analgesic and narcotic requirements, better cosmesis, and earlier return to normal activities.

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BIBLIOGRAPHY

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Bathla L, Fitzgibbons RJ Jr. Perspective on hernias: laparoscopic inguinal hernia repair. In: Zinner MJ, Ashley SW (eds.), Maingot’s Abdominal Operations, 12th ed. New York, NY: McGraw-Hill; 2013:Chapter 8B.

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Sherman V, Macho JR, Brunicardi F. Inguinal hernias. In: Brunicardi F, Andersen DK, Billiar TR, et al. (eds.), Schwartz’s Principles of Surgery, 9th ed. New York, NY: McGraw-Hill; 2010:Chapter 37.

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Which of the following is an absolute contraindication to laparoscopic inguinal hernia repair?

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(A) Urinary tract infection

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(B) Previous radical prostatectomy

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(C) Incarcerated hernia

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(D) Cirrhosis

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(E) Recurrence after open repair

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(B) Laparoscopic inguinal hernia repair ...

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