الفهرس 
Anatomy of inguinal region.Only 14 pages are availabe for public view
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Abstract
Surgery of the inguinal hernia has improved in recent years, with various techniques introduced to reduce the incidence of recurrence and other complications. The outcome of hernia surgery is highly surgeon dependent “no disease of the human body, belonging to the province of surgeons requires in its treatment a greater combination of accurate anatomical knowledge with surgical skill than hernia in all its varieties.
Inguinal hernia repair is the most common general surgical procedure in the world. The exact cause of inguinal hernia is still unknown but the following factors contribute in its occurrence. A preformed congenital sac, raised intra-abdominal pressure and weak abdominal musculature.
Bassini (1844-1924) is credited with developing the precursor to the modern inguinal hernia operation at the end of the 19th century. Later on, many modern modifications such as the Shouldice repair and the Lichtenstein ”tensionless” mesh repair have originated from it. The use of mesh for inguinal hernia repair has become the norm. It has reduced the recurrence rate from more than 15% to less than 5% on average and to less than 1% in the hands of expert surgeons.
Within a decade in the 1990s, laparoscopic enthusiasts had already described three forms of laparo-scopic repairs, namely: the intraperitoneal mesh (IPOM) repair, the trans-abdominal preperitoneal repair (TAPP), and the totally extraperitoneal (TEP) repair.
Laparoscopic inguinal hernia repairs, especially total extraperitoneal (TEP) inguinal hernia repair, have gained ground in the past few years. TEP is preferred over TAPP as it is less invasive and preserves the “peritoneal sanctity”.
Laparoscopic transabdominal pre-peritoneal (TAPP) repair of groin hernia was introduced as a treatment option for patients. An initial audit of our performance and introspection into our methods provided conviction and encouragement to persist with our efforts. Growing experience and encouraging results have strengthened this conviction.
However, fixation of the mesh is thought to contribute to increased postoperative pain and the risk of nerve injury. Nerve injury has been estimated to occur in 2% to 4% of laparoscopic inguinal hernia repairs with the most commonly injured nerves being the femoral branch of the genitofemoral nerve and the lateral femoral cutaneous nerve.
Prospective randomized studies of the necessity of fixing mesh to prevent recurrence of hernias following endoscopic preperitoneal inguinal hernia repair is controversial. Our results suggest that endoscopic preperitoneal inguinal hernia repair without mesh fixation does not appear to increase the incidence of hernia recurrence. Endoscopic inguinal hernia repair without mesh fixation leads to decreased hospital stays and fewer admissions for 23-hour observation and neuropathic complications compared with mesh fixation to the abdominal wall.