MIS Techniques: Lap TAPP and rTAPP
The transabdominal preperitoneal approach (TAPP) was described more than 25 years ago by several surgeons, and although the main principles are kept, there are several variations and details worth mentioning. Diverse technical details have emerged from formal research and surgical social media that are important for successful outcomes. While the TEP technique goes directly to the preperitoneal space, the TAPP technique reaches the same preperitoneal space after first entering the peritoneal cavity. Despite TAPP being considered as more invasive and taking longer to perform than TEP, it is surgically straightforward when it comes to understanding and learning the anatomy and the complexity of the repair; for this reason many surgeons see it as the first choice when learning MIS hernia repair.
Over the last three decades, the TAPP technique has evolved and has been refined, with successful innovations including central aspects like fixation and mesh types, but also creative and interesting (although never widely adopted) like combined approach, dissection aided by water, preperitoneal anesthetic injection to decrease pain, and self-expanding mesh. Therefore, we decided to include the more relevant steps proposed by many groups to reduce recurrences and minimize complications.
KeywordsLaparoscopic technique Laparoscopic hernia repair Robotic hernia repair rTAPP TAPP
- 3.Foro Hernia SoHAH (Sociedad Hispanoamericana de Hernia) https://www.facebook.com/groups/388472254649712/.
- 4.IHC—International Hernia Collaboration https://www.facebook.com/groups/herniacollab/.
- 15.Soper N. Mastery of endoscopic and laparoscopic surgery. Philadelphia: Lippincott Williams & Wilkins; 2009.Google Scholar
- 16.Memon MA, Fitzgibbons RJ. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). In: Scott-Conner CE, editor. The SAGES manual. New York: Springer; 2006.Google Scholar
- 17.Talar Tejirian (International Hernia Collaboration—Poll): “Never use a Foley because it’s simply not necessary so long as patient voids pre-op” and “Selectively use a foley for large incarcerated hernias or redo hernias”. 23 Oct 2017, 11:10 am. IHC—Facebook Post.Google Scholar
- 18.Shabino PJ, Greenberg JA. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) approach. In: Chen H, editor. Illustrative handbook of general surgery. Cham: Springer; 2016.Google Scholar
- 19.Inga-Zapata, Edmundo (International Hernia Collaboration—Closed Group): “Humidified gauzes are way more effective than dry gauzes when it comes to clear the tissue planes in TAPP”. 03 Nov 2017 21:02 hrs—Facebook Post.Google Scholar
- 20.Inga-Zapata, Edmundo (Foro Hernia SoHah—Closed Group): “La gasa húmeda funciona muchísimo mejor que una gasa seca cuando se trata de aclarar la visión para ver bien los planos de tejido y las estructuras”. 03 Nov 2017 21:14 hrs—Facebook Post.Google Scholar
- 21.Leroy J. Laparoscopic TAPP inguinal hernia repair. [ONLINE]. 2003. http://www.websurg.com/doi-vd01en1247e.htm. Accessed 1 Sept 2017.
- 36.Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Koeckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Reinpold W, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc. 2015;29(2):289–321.CrossRefGoogle Scholar