Tape Repair. Transabdominal Partial Extraperitoneal Repair for Laparoscopic Repair of Suprapubics Hernias

Background TAPE is suitable for laparoscopic repair of Suprapubic hernias where lower margin is within 5 cm from pubic arch. These hernias are known to occur after transverse or low vertical incisions in gynecological, urological or bowel related surgery. The repair of suprapubic hernias is as such difficult due to absent posterior rectus sheath, proximity to urinary bladder and essential neurovascular structures. Method After creation of pneumoperitoneum, the position of the ports is decided on the basis of the location of the suprapubic defect. 12 mm and Two additional ports of 5 mm are made on the lateral abdominal wall, mainly on the left flank to assess the hernial defect, previous scar and perform adhesiolysis. This allows space for adequate prosthetic overlap. The hernial content is completely reduced to expose the fascial borders of the defect. A peritoneal flap is dissected starting close to one anterior superior iliac spine (ASIS) and extended to the contralateral ASIS. The flap is inferiorly dissected till space of Retzius so that pubic arch and Cooper’s ligaments on either side are completely exposed. Medially, dissection is meticulous and carefully done avoiding any sort of iatrogenic injury to the urinary bladder. Close the defect with continuous suture with barbed suture of 1. A composite mesh (GORE® SYNECOR) of the appropriate size is chosen so that an overlap of at least 5 cm is achieved around the defect. The lower margin of the mesh must extend below the pubic arch by 1–2 cm to a low firm fixation to Cooper’s ligaments bilaterally with tackers CapSure™Permanent fixation. The rolled mesh is passed through a 12 mm port is spread inside the abdomen in a manner so that the surface with adhesion barrier faces the abdominal viscera. Spiral tacks are used to fix the mesh at two points on the Cooper’s ligaments on both sides. Circumferential fixation is also done at the mesh margins and around the margins of the hernial defect in the manner of double crowning. The peritoneal flap raised initially is made to reperitonealize the maximum possible part of the mesh. Results The main advantage of TAPE technique is suitable mesh overlap of more than 5 cm from the distal margin of the hernial defect. The fixation of the lower mesh margin to the Cooper’s ligaments on either side increases the strength of repair. The procedure does allow part of the mesh to remain in the extraperitoneal space. Since polypropylene meshes can be safely used, it allows to minimize the cost of procedure. Conclusion Laparoscopic repair of suprapubic incisional hernias is a safe and effective treatment option that offers several advantages over traditional open surgery. With careful patient selection and appropriate surgical technique, most patients can expect a successful outcome with low rates of recurrence and minimal complications.