**10. Pitfalls**

from the top and laid to the extraperitoneal space by the 10 mm camera trocars. With the help of two endograspers placed in the working ports, the patch is unfolded in the opposite direction and is laid to cover the existing hernia defect and potential hernia areas. It should be ensured that the area where the patch is applied covers it with a proper tension. When a limb patch is applied, the lower limb is passed under the spermatic cord and it is wrapped in a tie and is laterally joined to the lower limb (**Figure 9**). The lower edge of the patch is placed so that it remains at least 2 cm above the released hernia sheath. The locations and numbers are very important if the absorbable staple is preferred for the detection of the mesh. The basic rule, with different suggestions about this, is that the mesh must be placed on the ileo-pubic tract. We prefer to fix it with a total of two absorptive staples, one medially to the Cooper ligament and one to the back of the transverse fascia laterally. On the lateral edge of the spermatic cord there are anatomical areas defined as the triangle of pain mentioned above and the death triangle at the medial border. Staples must be avoided in these areas. Tissue adhesives have also been used today as fixing material. The use of drains varies according to experience and habits. We routinely use aspirative drain

Oral intake can be started a few hours after surgery and the patient is mobilized the same evening. The following day the patient can be discharged by removal of the drain. There is no

need to regulate postoperative medical treatment other than oral analgesics.

after TEP.

**9.6. Postoperative care**

**Figure 8.** Potential hernia areas for TEP procedure.

84 Hernia Surgery and Recent Developments

In this chapter, details take place as noted; details in current practice are given while applying the laparoscopic hernia repair. The points to be considered are evaluated for both techniques. In addition, the difficulties faced by the surgeon are itemized.

#### **10.1. TAPP**


dissected, as interference with the anatomical planes may result in attempts made for recurrent hernia.

**11. Complications and management**

ence are included.

**11.1. Local complications**

**11.2. Neurological complications**

**11.3. Cord and testicular injury**

In this section, complications related to laparoscopic inguinal hernia surgery, literature information about management of these complications and suggestions based on our own experi-

Laparoscopic Inguinal Hernia Repair: Technical Details, Pitfalls and Current Results

http://dx.doi.org/10.5772/intechopen.76942

87

The most common complications are serous fluid deposits (seroma) and bleeding(hematoma) which may develop during operation. Patients should be informed in the preoperative period about these complications. Postoperative seromas usually resorb spontaneously within 2 weeks and do not require treatment. Therapeutic drainage needs arise in the presence of seroma persistent for longer than 6–8 weeks or in the presence of seroma causing clinical symptoms. The use of peroperative aspirative drains in risky patients of who may be predicted seroma and hematoma development may prevent the development of these complications. Scrotal elevation is recommended in the postoperative period. If abdominal wall ecchymosis occur, mechanical compression, cold application and medical treatment can be tried. Subcutaneous emphysema is often untreated and spontaneous. In rare occasional

The treatment of chronic pain syndromes after laparoscopic hernia surgery is often long and difficult. Chronic postoperative pain has been reported in up to 63% of all groin repairs and significantly affects clinical outcomes. The pain following laparoscopic surgery is usually neuropathic pain. The cause is usually the damage or trapping of the lateral femoral cutaneous or femoral branch of the genitofemoral nerve. Clinically it occurs as acute burning and/ or crushing pain in a particular dermatome. Mareljia parestetika is the name of a pain clinic that develops after a lateral femoral cutaneous nerve injury and persistent paresthesia lateral of the femoral area. It is recommended to apply corticosteroids or anesthetic injections which can be applied at rest, cold application, NSAIDs, physical therapy, locally. Osteitis pubis is; the name of the pain clinic that occurs due to public inflammation and arises especially on the middle of the groin or on the pubis, especially with femoral adduction. Diagnosis can be made by excluding recurrent hernia diagnosis radiographically and performing bone imaging. The treatment approach is the same as neuropathic pain. Often, 6 months are required to respond to treatment. However, if the cure is not available, the orthopedic consultation may

Ischemic orchitis should be considered in the complaints of hardened, enlarged and painful testicles that appear about 10 days after the repair of the inguinal hernia. It is often self-limiting. It is usually the result of a possible damage to the pampiniform plexus, not the testicular artery. Ultrasound can distinguish necrosis or ischemia. If testicular necrosis is detected,

hydrocele cases, it will be more appropriate to consult with a urologist.

be needed to consider possible bone resection or curettage options.


### **10.2. TEP**

