Lap. Tapp Made Easy Using The Innovative Tumescent Technique

Lap. Tapp Made Easy Using The Innovative
Tumescent Technique allows a Joyful
Surgery.
Under Supervision of
Head of Department
General Surgery
Dr Moh. Al-Jasmi
Al-Jahra Hospital
Kuwait
By
Dr Said Umer
MBBS & FCPS
Department Of General Surgery
Unit B 1

Learning Objectives
1:- Introduction and Types of Laparoscopic Hernia Repairs.
2:-Laparoscopic Inguinal canal anatomy , landmarking and highlights of approach.
3:-Concept of The Critical View of the Myopectineal Orifice. (Visuals)
4:-The Most Common difficulties/pitfalls encountered during Lap.TAPP procedures ?
5:-The concept of Tumescent Lap TAPP. and its imp. in Lap hernia surgery in surgery ?
6:-The Tumescent technique….what is it ? How developed this Ideas and To see how
effective this technique is in Laparoscopic Hernia Repair?
7:-Article discussion on Laparoscopic TAPP repair following tumescent injection: The
patient outcomes and feasibility for surgeons

1:- Introduction and Types of Laparoscopic Hernia Repair.

2:-Laparoscopic Inguinal canal anatomy , landmarking and highlights
of approach.

2:-Laparoscopic Inguinal canal anatomy , landmarking andhighlights of approach.
Continued

2:-Laparoscopic Inguinal canal anatomy , landmarking andhighlights of
approach.Continued

2:-Laparoscopic Inguinal canal anatomy , landmarking and highlights of approach. Continued

Continued

2:-Laparoscopic Inguinal canal anatomy, landmarkingand highlights of approach.Continued

2:-Laparoscopic Inguinal canal anatomy , landmarking and highlightsof approach.
Continued

2:-Laparoscopic Inguinal canal anatomy , landmarking and highlightsof
approach. Continued

2:-Laparoscopic Inguinal canal anatomy , landmarking and highlightsof approach. Continued

2:-Laparoscopic Inguinal canal anatomy and landmarking.

3:-Conceptof TheCritical Viewof the Myopectineal Orifice. (Visuals)

4:-TheMostCommondifficulties/pitfalls encounteredduringLap.TAPPprocedures ?
Howto minimize these problems, interruptionsduring Lap.TAPP?

4:-The Most Common difficulties/pitfalls encounter during Lap.TAPP
procedures ?

5:- The concept of Tumescent Lap TAPP. and its importance Lap
hernia surgery in surgery ?
We made a Hypothesis whether we could use in the Tumescent
technique in Lap.TAPP which usually used by plastic surgeons for
liposuction.?
WHAT IS TUMESCENT TECHNIQUE
This means nothing more than creating a bulge in the peritoneal
Borrowed Fromplastic surgery( Liposuction.breastaugmentation)
Importance Lap hernia surgery in surgery ?
It separates the vital structures abutted to the parietal peritoneum e.g
● Vas deferens
● Gonadal vessels
● External Iliac vessels
and avoiding minor haemorrhage through injured micro-vasculature e.g Venules and Arterioles in dissection during
peritalization.

HowdevelopedthisIdeas andTo see howeffective thistechnique is in laparoscopic
hernia repair?
The idea is taken from plastic surgery
technique called liposuction preceded by
Tumescent local Anesthesia and considered to
adopt with , In which surgeons give local
anaesthesia before the start of the liposuction
procedure to create a safe zone between the
anterior rectus sheath and skin.
Tumescent local anesthesia is a form of
local anesthesia, which has been used for
several dermatosurgical procedures,
particularly liposuction. It is a technique
in which a dilute local anesthetic solution
is injected into the subcutaneous tissue,
until it becomes firm and tense.

5:- The concept of Tumescent Lap TAPP. and its advantages in Lap. hernia
surgery in surgery?
Then I googled the relative keywords "Use of Tumescent solution in Lap.TAPP.
I found a fellow surgeon Mr.Hiromi Tokumur who performed the procedure in Japan in 2017.

Let's have a look the Japanese Tumescent TAPP Visuals

And this technique was first practiced at DHQ Teaching
Hospital, Gujranwala, with far-reaching results.

The patient outcomes and feasibility for surgeons
Surgeon feasibility
Bloodless operative field
Clear anatomy of CV of MOF
Easy to locate the vital structure
Less Time consuming procedure
Need low learning curve
Patient outcome
Same is conventional Lap TAPP.
Less intraoperative and postoperative pain
Early discharge
Since there is smooth dissection during this
technique there is less chance of post seroma and
hematoma formation and low morbidity rate.

Introduction
Already discussed
MATERIALANDMETHOD
Between March 2019 and Feb 2021, tumescent was
injected in 35 patients with total of 38 inguinal and
one femoral hernia (Table 1) after permission from
Ethical Committee.
Technique: GA with endotracheal intubation,
Lap TAPP approach details
tumescent solution consist of 20 ml 1%lidocaine
0.2mg adrenaline and 40-80 ml Normal Saline

RESULTS
j;;
The average 80-100 ml volume of tumescent used in each case. No complication related to cardiovascular or
respiratory ware encountered during or after
Surgery.
CONCLUSION
We concluded from our results that this new technique for inguinal hernia repair has favourable outcome with
less side effects and it has small learning curve make it easy procedure for the new
trainee or senior registrar to use it for hernia repair and to learn it
quickly.
Conflict of interest: Nil

LaparoscopicTAPPrepair followingtumescentinjection: Thepatientoutcomes andfeasibility for
surgeons. Please stay it's a last Visual

Thanks for you patience
If you any Question ?

Referance
1. Daes J. Standardization of hernia surgery (Letter to the Editor). Hernia. 2015;19:1039–1040. 2. Tetik C,
Arregui ME, Dulucq JL, et al. Complications and recurrences associated with laparoscopic repair of groin hernias.
A multi-institutional retrospective analysis. Surg Endosc. 1994;8:1316–1323. 3. Phillips EH, Rosenthal R, Fallas
M, et al. Reasons for early recurrence following laparoscopic hernioplasty. Surg Endosc. 1995;9:140–145. 4. Felix
E, Scott S, Crafton B, et al. Causes of recurrence after laparoscopic hernioplasty: a multicenter study. Surg Endosc.
1998;12:226–231. 5. Bittner R, Leibl B, Kraft K, et al. [Laparoscopic hernioplasty (TAPP): complications and
recurrences in 900 operations.]. Zentralbl Chir. 1996;121:313–319 [in German]. 6. Leibl BJ, Schmedt CG, Kraft K,
et al. Recurrence after endoscopic transperitoneal hernia repair (TAPP): causes, reparative techniques and
results of the reoperation. J Am Coll Surg. 2000;190:651–655. 7. Feliu-Pala X, Martin-Gomez M, Morales-Conde
S, et al. The impact of the surgeon’s experience on the results of laparoscopic hernia repair. Surg Endosc.
2001;15:1467–1470. 8. Alvarez R. Dermatome mapping: preoperative and postoperative assessment. In: Jacob
BP, Chen DC, Ramshaw B, et al., eds. The SAGES manual of groin pain. Cham, Switzerland: Springer; 2016:277–
292. 9. Daes J. Prevention of pain: optimizing the laparoscopic TEP and TAPP techniques. In: Jacob BP, Chen DC,
Ramshaw B, et al., eds. The SAGES manual of groin pain. Cham, Switzerland: Springer; 2016:389–396. 10. Kukleta
JF. Causes of recurrence in laparoscopic inguinal hernia repair. J Minim Access Surg. 2006;2:187–191.

References
1. Hernia The EU, Collaboration Trialists. Laparoscopic compared with open methods of groin hernia repair:
systematic review of randomized controlled trial. Br J Surg. 2000;87:860–867. doi: 10.1046/j.1365-2168.2000.01540.x.
[PubMed] [CrossRef] [Google Scholar]
2. Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh
techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc. 2005;19:188–199.
doi: 10.1007/s00464-004-9126-0. [PubMed] [CrossRef] [Google Scholar]
3. Novitsky YW, Czerniach DR, Kercher KW, Kaban GK, Gallagher KA, Kelly JJ, et al. Advantages of laparoscopic
transabdominal preperitoneal herniorrhaphy in the evaluation and management of inguinal hernias. Am J Surg.
2007;193:466–470. doi: 10.1016/j.amjsurg.2006.10.015. [PubMed] [CrossRef] [Google Scholar]
4. Yang GP, Chan CT, Lai EC, Chan OC, Tang CN, Li MK. Laparoscopic versus open repair for strangulated groin
hernias: 188 cases over 4 years. Asian J Endosc Surg. 2012;5:131–137. doi: 10.1111/j.1758-5910.2012.00138.x.
[PubMed] [CrossRef] [Google Scholar]
5. Davis CJ, Arregui ME. Laparoscopic repair for groin hernias. Surg Clin N Am. 2003;83:1141–1161. doi:
10.1016/S0039-6109(03)00122-1. [PubMed] [CrossRef] [Google Scholar]

Lap. Tapp Made Easy Using The Innovative Tumescent Technique

In this document

More Related Content

What's hot

Similar to Lap. Tapp Made Easy Using The Innovative Tumescent Technique

Recently uploaded

Lap. Tapp Made Easy Using The Innovative Tumescent Technique