P-080 LAPAROSCOPIC TRANSABDOMINAL RETROMUSCULAR UMBILICAL PROSTHETIC HERNIA REPAIR (LAP-TARUP) & TAPP-INGUINAL IN A SINGLE TIME: A GOOD OPTION IN OBESE PATIENTS?

Abstract

Abstract Aim The association between midline hernias (primary-or-incisional) and inguinal-hernias is not uncommon, nor is its association with obesity, which increases its incidence every day. In obese patients, the laparoscopic-eTEP-approach to treat ventral hernias is a feasible option but with greater surgical difficulty and worse ergonomics. The laparoscopic-TARUP-approach(TransAbdominal-Retromuscular-Umbilical-Prosthetic-Hernia-Repair) offers the advantages of MIS with better ergonomics in obese patients or those with irreducible incarcerated hernias. Material and Method 77-year-old male patient with obesity (BMI:37.58kg/m2), previous laparoscopic gallbladder surgery,who presents umbilical eventration(EHS: M2–3W2(8cm)) associated with diastasis,in addition to incoercible left inguino-scrotal hernia. Results 5ports are used to perform the surgery.Initially,the classic TAPP-approach of the left inguinal-hernia is performed.After that the video-endoscope is changed to the location of the right flank and continues with the opening at the lateral edge of the posterior sheath of the right-rectum, the retromuscular-space is dissected and the supraumbilical cross-over and subsequent opening of the posterior contralateral sheath is performed.The dissection and reduction of the hernial sac is continued, and the dissection of the left retromuscular-space is completed.The anterior hernia defect is closed and diastasis is replicated with Stratafix-0.Closure of the posterior sheath of the rectums is performed with V-Lock 3–0. A 21×24cm PVDF-mesh is placed in a retromuscular position fixed with Fibrin, and the lateral opening is closed with V-Lock.The patient had a favourable postoperative period. Conclusions The TARUP-approach in midline hernias in obese patients is a valid,safe and better ergonomic option, and is also useful for simultaneously resolving large inguinal hernias by TAPP-approach,as in the case presented.