Perioperative management - Laparoscopic totally extra-peritoneal (TEP) inguinal hernia repair with DynaMesh ENDOLAP 3D

Primary and recurrent hernia in:

• Inguinal hernia
• Femoral hernia
• Unilateral
• Bilateral with simultaneous repair

Absolute contraindications:

• All general disorders where general anesthesia and/or increased abdominal pressure would present high surgical risks, e.g., in massive COPD or severe heart failure.
• Extensive previous open surgery in the lower abdomen, e.g., open prostatectomy, cesarean section, etc. In these cases, the prevesical and preperitoneal space cannot be freed enough. Standard open appendectomy usually does not present any major problem.
• Infected surgical field.
• Patients refusing foreign body material or with known allergies to it.

Relative contraindications:

• Patients under long-term anticoagulants. Here, each case has to be considered individually.
• Giant hernias and scrotal hernias do not lend themselves easily to this technique because the content of the hernial sac can hardly be reduced by minimally invasive means and very large defects cannot be reliably closed by this technique.
• Massive obesity in patients can significantly complicate this technique and even make it impossible.

• Medical history
• Physical examination
• optional or complementary ultrasonography; in unclear recurrences or obese patients, cross-sectional imaging (CT) is also recommended.
• Routine lab panel: Complete blood count, coagulation, creatinine, Na, K; in case of previous medical disorders possibly additional pertinent lab panels
• ECG
• Chest film, depending on age and medical history

• Mark the affected side
• 1/2 hour before skin incision a single-shot antibiotic regimen is recommended, e.g., with 2nd generation cephalosporin

General:

• Deep venous thrombosis of the pelvis/lower extremity
• Pneumonia
• Bleeding, hematoma
• Wound infection
• Exuberant scarring

Specific:

• Injury to spermatic cord with transection of the spermatic duct
• Vascular injury with subsequent testicular dysfunction or even loss
• Injury to sensory nerves in the surgical field
• Chronic pain due to nerve irritation
• Hypersensitivity reaction to the mesh material with seroma
• Implant infection with subsequent necessity of mesh removal
• Recurrent hernia
• Intraoperative conversion to open procedure
• Injury to the femoral vessels
• Injury to abdominal organs