Voeller G R, Mangiante E C
Dept. of Surgery, University of Tennessee, Memphis 38163, USA.
Scand J Gastroenterol Suppl. 1995;208:67-73. doi: 10.3109/00365529509107765.
After having performed over 200 transabdominal preperitoneal (TAPP) laparoscopic hernia repairs with no recurrences and no neuropathies, we recently changed to a totally preperitoneal repair due to the development of a balloon trocar that easily 'creates' the preperitoneal space.
The totally preperitoneal operation is similar to our TAPP procedure in that it involves detailed delineation of Cooper's ligament, spermatic cord and transversus abdominis arch with fixation of mesh to Cooper's ligament and arch for an anatomic tension-free hernia repair.
Our early experience consists of 60 hernia repairs in 50 patients (46 male, 4 female). There were 32 direct, 26 indirect and two femoral hernias. Eight hernias were recurrent. The operation takes approximately 1 h. There has been no morbidity. As with the TAPP procedure, minimal postoperative discomfort and return to regular activity within 2 to 3 days is the norm.
We believe that the avoidance of the peritoneal incision and the attendant risks of intraabdominal adhesions associated with the TAPP procedure make the totally preperitoneal technique the preferred method of laparoscopic hernia repair.
在成功实施了200多例经腹腹膜前（TAPP）腹腔镜疝修补术且无复发和神经病变后，由于一种可轻松“创建”腹膜前间隙的球囊套管针的出现，我们最近改为了完全腹膜前修补术。
完全腹膜前手术与我们的TAPP手术相似，即都需要详细描绘库珀韧带、精索和腹横肌弓，并将补片固定于库珀韧带和腹横肌弓以进行解剖学无张力疝修补。
我们的早期经验包括为50例患者（46例男性，4例女性）实施了60例疝修补术。其中有32例直疝、26例斜疝和2例股疝。8例为复发性疝。手术大约需要1小时。无并发症发生。与TAPP手术一样，术后不适轻微，2至3天内即可恢复正常活动是常态。
我们认为，避免腹膜切口以及TAPP手术相关的腹腔内粘连风险，使得完全腹膜前技术成为腹腔镜疝修补的首选方法。
