V-049 THE IMPORTANCE OF PROCTORING- MISSING THE “TEN GOLDEN RULES” OF TAPP

Abstract

Abstract Claus in 2020 published the “Ten golden Rules” for a minimally Invasive safe approach to the Myopectineal Orifice. During the first proctoring session of a TAPP procedure for the repair of a left side inguinal hernia we revised the application of the rules by the trainee. The proctor invited the trainee to study the paper before the session of surgery. The first and the last 3 rules were followed by the trainee but there was a lack of the 4-5-6-7 rules. The knowledge of the anatomy of the inguinal region allows the surgeon to create a preperitoneal box for a mesh at least 15×15cm covering all the possible origins for hernia. In particular we focused our attention to the rule 7. The trainee was missing to check the emptiness of the deep inguinal ring that was covered, in the iliopubic tract, by fat sliding to the scrotal region. After dissection a big cord lipoma was reduced in the abdomen. Missing this rule should be a problem because the patient could feel,after the inguinal hernia repair, a bulging and discomfort in the inguinal region. The imaging could not be helpful and the clinical visit could report a “false Positive” for the presence of bulging without a real hernia. In a similar case we reoperate a man after a TAPP procedures for a bulging in inguinal region, pain and discomfort miming a recurrence but we only found a large cord lipoma that we resected.