Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2020; 12(7): 307-325
Published online Jul 27, 2020. doi: 10.4240/wjgs.v12.i7.307
Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults
Daiki Yasukawa, Yuki Aisu, Tomohide Hori
Daiki Yasukawa, Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
Yuki Aisu, Tomohide Hori, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
Author contributions: Yasukawa D and Hori T wrote this review; Yasukawa D originally drew all illustrations and schemas; Yasukawa D, Aisu Y and Hori T performed laparoscopic surgeries, assessed important papers, and provided academic opinions; Hori T supervised this review; Yasukawa D and Hori T contributed equally to this work.
Conflict-of-interest statement: Neither author has a potential conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tomohide Hori, PhD, MD, FACS, Associate Professor, Attending Doctor, Surgeon, Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoinkawara-cho, Sakyo-ku, Kyoto 606-8507, Japan. horitomo55office@yahoo.co.jp
Received: December 25, 2019
Peer-review started: December 25, 2019
First decision: March 24, 2020
Revised: April 8, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: July 27, 2020
Processing time: 210 Days and 0.3 Hours
Abstract

Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of “tension-free repair” is generally accepted, and surgical repairs with mesh are categorized as “hernioplasties”. Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.

Keywords: Inguinal hernia; Femoral hernia; Obturator hernia; Laparoscopic surgery; Laparoscope; Anatomy

Core tip: A high-quality hernia repair is seriously required for groin hernias. Surgeons should have good knowledge of the relevant anatomy (e.g., the preperitoneal space, myopectineal orifice, topographic nerves, regional vessels). Currently, laparoscopic surgery has therapeutic potential for hernioplasty, and laparoscopic transabdominal preperitoneal repair seems to be a powerful technique for use in adult patients. Both technical skill and anatomical familiarity are important for safe, reliable hernioplasty.