The TAPP technique (transabdominal preperitoneal patch technique) is a gentle and safe procedure for the removal of inguinal hernias. The minimally invasive procedure is safe and is used very frequently today. Here you will find further information as well as selected TAPP specialists and centers.
An inguinal hernia, also known as an inguinal hernia, is a hernia sac in the groin area. Men are usually affected.
Normally, the inguinal canal, which contains the spermatic cord and the vessels supplying the testicles, is located at the inguinal level. If this canal expands, this leads to a protrusion of the peritoneum (hernia sac) and the inguinal hernia is formed.
The hernia sac contains abdominal contents and, in extreme cases, parts of the intestine. A swelling may be visible and palpable from the outside. This leads to pain or a feeling of pressure/instability, particularly during movement.
If parts of the intestine get caught in the hernia sac, in the worst case it can become trapped and a medical emergency situation arises. This requires immediate surgery.
An inguinal hernia usually develops in adulthood (acquired inguinal hernia). The inguinal canal is a natural weak point in the abdominal wall anatomy of the human body.
Illustration of an inguinal hernia © designua | AdobeStock
Possible causes of a hernia in the inguinal region in the course of life are a decrease in connective tissue strength and an increase in internal abdominal pressure (e.g. in the case of obesity). This results in a hernia gap, which is now the cause of the symptoms.
But hernias are also found in children. These are associated with an inguinal canal(processus vaginalis testis) that has remained open during the growth phase. In this case, we therefore speak of congenital inguinal hernias.
The diagnosis "inguinal hernia" is made by the doctor's examination and usually requires no further assistance. Exceptionally, in uncertain cases, an ultrasound examination can also provide information about the situation. In most cases, however, the examiner's clinical experience is sufficient.
Inguinal hernias should be treated surgically, especially if symptoms are present, as spontaneous recovery never occurs.
There are various surgical procedures for treating an inguinal hernia, which should be individually adapted to each patient. In principle, a distinction is made between
In the open surgical technique, the hernia sac is separated from the spermatic cord via an external incision and pushed back inwards.
The surgeon then closes the hernial orifice and the supporting abdominal wall layer with a continuous suture (e.g. as an open repair according to Shouldice).
This technique is mainly used for the following patient groups
Minimally invasive inguinal hernia repair, which has been widely used since the mid-1990s, is a very elegant and largely atraumatic surgical technique. Like the classic open method, it is now a standard procedure in almost every clinic.
The operation using the "keyhole surgery" technique is based on the minimally invasive insertion of a plastic mesh to reinforce the abdominal wall. There are generally two equivalent procedures, the TEP and TAPP techniques.
In the TEP technique(total transperitoneal plasty), a small incision is first made at the navel between the peritoneum and the abdominal wall layer. A working space is then created by injecting CO2 gas into the abdominal cavity. CO2 is an endogenous gas and therefore completely harmless to the human body.
The hernia situation can then be examined under multiple magnification using a special camera. In addition, two further, smaller working accesses are made to detach the hernia from the inside of the spermatic cord.
The next step is to modulate the anti-allergic, biocompatible plastic mesh onto the well-prepared and freed hernial orifice. This serves to reinforce the abdominal wall, which is weakened and unstable in this area.
All work steps are carried out on the monitor with multiple magnification in HD quality.
Minimally invasive procedure in the abdominal area © Iryna | AdobeStock
The TAPP technique(transabdominal preperitoneal patch technique) is based on a slightly different principle.
Here, too, a small access is chosen above the navel, but this time the necessary CO2 gas is introduced into the entire abdominal cavity. This significantly increases the surgeon's working area so that the operation can be started on the monitor (see above) after camera access.
Here too, two further sleeve-shaped working accesses are created (each via punctiform, 0.5 - 1 cm long skin incisions). In the first step, the entire abdominal cavity can be assessed and a first impression of the size of the hernia to be operated on and the other side can be obtained.
The dissection begins with a semi-circular incision of the peritoneum just above the hernial orifice. Rod-shaped instruments (scissors, forceps) are used as working tools for this. After retrieving the hernia sac from the inguinal canal, the entire inguinal region is well dissected. A plastic mesh (polypropylene), usually 10 x 15 cm in size, can now be inserted without folds.
Finally, the peritoneum is continuously closed with an absorbable suture, thus completing the operation.
The atraumatic, gentle surgical technique means that hardly any pain is to be expected. In addition, the tension-free mesh allows the patient to take weight quickly after the wound has healed. TAPP is a cosmetically flawless procedure, as virtually no visible scars remain.
As both groin regions can be assessed, both sides can be treated in one operation if necessary. The abdominal region and abdominal organs are fully inspected and any other problems are assessed. The recurrence rate appears to be lower compared to the open surgical technique without mesh stabilization.
After the operation, the patient is immediately mobile and able to walk again. Short-term pain is limited in most cases and can be treated well with mild painkillers.
Discharge is possible on the following day and full weight-bearing is permitted again after one to two weeks (tension-free procedure). The method is therefore ideal for athletes, highly active people and patients with physically demanding work.
The TAPP technique is a gentle and safe procedure for the removal of inguinal hernias. It has become very important in hernia surgery in recent years.
With the correct indication, individual treatment planning and an experienced surgeon, it is a safe and good procedure with very few side effects for the patient.
