Laparoscopic, transaabdominal, preperitoneal inguinal hernia repair (TAPP)

TAPP Repair

The TAPP repair can’t be performed in only few cases. The most important contraindication is the inability to tolerate general anesthesia; sometimes the spinal anesthesia is used though. Also patients with blood coagulation disorders cannot undergo the surgery, because eventual bleeding in the preperitoneal space might be difficult to control after the operation. Another contraindication are intra-abdominal infections because of limitations in using prosthetic meshes.

Some relative contraindications are previous abdominal surgery (pelvic surgery in particular) and depend on the type and degree of expected adhesions, the surgeon’s level of comfort with adhesiolysis, and the nature of the hernia.

Previous prostate surgery was once considered an absolute contraindication, because it might have disrupted the preperitoneal space. With time TAPP procedure was improved; now previous prostate surgery is thought to be a relative contraindication and TAPP can be performed safely. However, the TAPP repair is more difficult in these cases and carries a higher morbidity.

Large inguinoscrotal hernias generally are not a contraindication, but can make the surgery difficult – reducing these indirect sacs laparoscopically is hard to manage. In these cases, it is recommended to conduct the operation using the open approach, especially when it is being performed by an inexperienced surgeon.

Surgeons should consider benefits and risks of TAPP repair compared with open repair. To match the right method to the patient the surgeon needs to know benefits, indications, and contraindications of TAPP repair and TEP.