الفهرس 
Anatomy of the Anterior Abdominal WallOnly 14 pages are availabe for public view
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Abstract
The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculotendinous layer.
The exact cause of inguinal hernia is still unknown but the factors contributing in its occurrence include; preformed congenital sac, chronic passive rise in the intra-abdominal pressure and weak abdominal wall.
A great revolution in inguinal hernia repair surgery occurred during the last two decades with the introduction of tension-free hernia repair by Lichtenstein in 1989. Because of its effectiveness and simplicity, it has almost replaced sutured repair and become the current gold standard.
The preperitoneal approach for mesh insertion is an attractive alternative technique with many advantages as it makes all potential hernia sites exposed helping in rapid diagnosis and repair. It allows for application of a mesh that is of larger size, better overlap and without the need of fixation. It is suitable for treatment of recurrence after classic repairs.
Nyhus, Stoppa, and Wantz are among the famous leaders who adopted the open preperitoneal repair. Nyhus incorporated a preperitoneal slit Prolene mesh in addition to the approximation of the transversalis fascia to Cooper’s ligament. Stoppa developed GPRVS, which utilized midline incision to insert a large chevron-shaped “Dacron” mesh that entirely and bilaterally replaced the transversalis fascia over the myopectineal orifice of Fruchaud without repairing the defective wall. Wantz utilised Stoppa”s technique to one side and fixed the upper border of his diamond-shaped “Mersilene” mesh to the incision “unilateral GPRVS”.
Results obtained from those techniques were attractive enough to make them compete with the classic repairs in the treatment of recurrent and even primary inguinal hernias.
Meanwhile, in the early 1990s, a second revolution in the treatment of inguinal hernia occurred with the application of laparoscopic surgery. It combines the advantages of minimally invasive surgery, tension free repair and mesh hernioplasty
Two laparoscopic techniques have become the most commonly used: the transabdominal preperitoneal repair (TAPP) and the totally extraperitoneal (TEP) endoscopic repair.
The first TEP inguinal hernia repair was described by McKernan in 1993. This approach involves preperitoneal dissection and mesh placement without entering into the abdominal cavity. It is preferred over TAPP as it is less invasive and preserves the “peritoneal sanctity”.
Both of the posterior open preperitoneal and the endoscopic TEP were dominated by the simpler and more fashionable Lichtenstein and TAPP repairs. As general laparoscopic skills and experience increased, there has been gradual shift from TAPP to TEP. TEP is now in turn, reviving back the concept of posterior open preperitoneal repair.
The aim of our study is to compare the outcome results of the laparoscopic total extraperitoneal TEP hernia repair with mesh to those of open preperitoneal repair with mesh.
In our study, 60 patients were included divided on two groups, 30 for each. group O; underwent open preperitoneal repair with mesh, group L; underwent laparoscopic TEP repair with mesh. Follow up of patients was done in the out-patient clinic at Benha university hospitals , 7 days after discharge then at 1, 3, 6 and 12 months postoperatively till December 2020.
Both groups were compared in terms of operative technique, operative time, intra & post operative complications, early post operative pain within one week, hospital stay, restriction of physical activity and incidence of recurrence and chronic pain.
Interpretation of results revealed that the TEP repair appeared technically more difficult as evidenced by increased operative time, conversion and more intraoperative –although minor- complications. It needs a long learning curve and a dedicated team for technique excellence. However, it is preferred because it is associated with less acute postoperative pain, less wound-related complications, shorter hospital stay and rapid return to normal activity. It is also followed by good cosmetic result and general patient satisfaction.
Both techniques are considered safe and effective with similar rates of recurrence and chronic pain although further wider scale studies are recommended.