News Feed Discussions Concerns with laparoscopic repair

  • Concerns with laparoscopic repair

    Posted by pbrown on February 18, 2015 at 6:38 pm

    It is reported that with TEP repair, the mesh can sometimes disrupt the peritoneum and
    adhere to the bowel causing bowel loops. Another concern is that the mesh can
    come into contact with the femoral nerve. To what extent should these concerns influence
    one’s decision to undergo laparoscopic repair?

    groundfaller replied 8 years, 12 months ago 4 Members · 3 Replies
  • 3 Replies
  • drtowfigh

    Moderator
    March 7, 2015 at 7:17 pm

    Concerns with laparoscopic repair

    Any “posterior” repair may have a risk of disrupting the peritoneum and this a risk of the mesh coming in contact with the intestine. So a laparoscopic repair (TEP or TAPP) or an open repair with a posterior component (PHS, Plug, Kugel) can all have this risk. This is rare and even if it happens it is even more rare for it to cause an intestinal obstruction. The peritoneum may tear due to technique or a lot of scar tissue. Also, some people have really thin peritoneum and are at higher risk for the peritoneum to tear. It is unpredictable. In my mind this concern is certainly not a reason to choose lap vs open repair. There are much more important differences in risks and benefits that should be considered when choosing what is best for you.

    Regarding the femoral nerve: injury to that would be a reportable case. I have seen it but it should never happen. It actually is more likely to happen with open repair due to too lateral of a stitching or too tight of a stitching. Once again: almost never an issue. The femoral nerve is a deep structure and lateral, so it is very difficult to injury it laparoscopically.

  • groundfaller

    Member
    March 1, 2015 at 11:21 am

    Concerns with laparoscopic repair

    I had open repair and still had significant nerve damage. At least that is my best guess since the surgeon who performed the operation discovered nothing afterwards and is offering no more treatment advice. I am on my own to find a doctor/treatment that will help me. The options seem pretty awful and with daily pain and limited activities, my funds are running out and my patience has worn thin. Find the best doctor that money can buy or keep the hernia. I have serious regrets. This is a nightmare. I could have been much, much, much happier without medical “help.”

  • RJ

    Member
    February 19, 2015 at 12:15 am

    Concerns with laparoscopic repair

    These are valid questions as are many others. From what I understand there are three major nerves in the area, genitofemoral, ilioinguinal, iliohypogastric, and who knows how many vessels and other structures that could be damaged.

    I’ve noticed that laparoscopic surgery is the default recommendation of many doctors if you have hernia repair in an elective setting, whatever that suggests. One would hope that if someone is offering the laparoscopic approach, they’d know what they’re doing and how to avoid nerves in the area, and be well aware of techniques to avoid mesh related complications. To the untrained eye (like mine, just a patient) the laparoscopic TEP field of vision looks like… absolutely nothing identifiable at all. If you don’t mind watching surgical videos, watch a TEP repair on YouTube, it certainly gives you an appreciation for good surgeons since it literally looks like nothing at all. This contrasts greatly to the YouTube videos of standard open repair, where anatomy is easily visualized even by a total novice.

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