P-051 TAPP IN A COMMUNITY HOSPITAL SETTING : AN EXPERIENCE OF OVER 1000 CASES

Abstract

Abstract Aim We want to share and discuss what we have learned from our 20-year experience in TAPP procedures Material and Methods We use only all 5 mm trocars, instruments, and 30-degree optics and we always use low intraabdominal pressure (10mmHg). The major technical trick is to carefully prepare the peritoneum flap all around, like a cone, just in order to let the mesh perfectly lie down on the inguinal area. Results Our TAPP experience is almost more than 1000 cases, elective as an emergency. We use a 10×15 cm LW macroporous monofilament polypropylene mesh. Besides the well known needed physical characteristics of the mesh, on the surgeon's side, a mesh should be smooth, stiff, wide enough to cover all the possible defects, easy to handle, and, especially for its possible use in laparoscopy, with a certain degree of and thickness just what it is needed in order to let it pass through a 5 mm trocar once rolled up. We do not use to fix the mesh anymore because we do believe in the mesh pushed versus the abdominal wall by the intra-abdominal pressure, and in the exact size of the (10×15 cm). Only in case of huge direct hernia we do “lift” without tension the transversalis fascia. Conclusions Most of the advantages of laparoscopy rely on the minimal access and therefore the benefits of this technique will be greater as the access becomes smaller, together with a no fixed LW mesh.