الفهرس 
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Abstract
Surgery of the inguinal hernia has improved in recent years, with various
techniques introduced to reduce the incidence of recurrence and other
complications. The outcome of hernia surgery is highly surgeon dependent ―no
disease of the human body, belonging to the province of surgeons requires in its
treatment a greater combination of accurate anatomical knowledge with surgical
skill than hernia in all its varieties.
Inguinal hernia repair is the most common general surgical procedure in
the world. The exact cause of inguinal hernia is still unknown but the following
factors contribute in its occurrence. A preformed congenital sac, raised intraabdominal
pressure and weak abdominal musculature.
Bassini (1844-1924) is credited with developing the precursor to the
modern inguinal hernia operation at the end of the 19th century. Later on, many
modern modifications such as the Shouldice repair and the Lichtenstein
”tensionless” mesh repair have originated from it. The use of mesh for inguinal
hernia repair has become the norm. It has reduced the recurrence rate from more
than 15% to less than 5% on average and to less than 1% in the hands of expert
surgeons.
Within a decade in the 1990s, laparoscopic enthusiasts had already described
three forms of laparo-scopic repairs, namely: the intraperitoneal mesh (IPOM)
repair, the trans-abdominal preperitoneal repair (TAPP), and the totally
extraperitoneal (TEP) repair.
Laparoscopic transabdominal pre-peritoneal (TAPP) repair of groin hernia
was introduced as a treatment option for patients. An initial audit of our
performance and introspection into our methods provided conviction and
encouragement to persist with our efforts. Growing experience and encouraging
results have strengthened this conviction.
However, fixation of the mesh is thought to contribute to increased
postoperative pain and the risk of nerve injury. Nerve injury has been estimated
to occur in 2% to 4% of laparoscopic inguinal hernia repairs with the most
commonly injured nerves being the femoral branch of the genitofemoral nerve
and the lateral femoral cutaneous nerve.
Prospective randomized studies of the necessity of fixing mesh to prevent
recurrence of hernias following endoscopic preperitoneal inguinal hernia repair
is controversial.
Our results suggest that endoscopic preperitoneal inguinal hernia repair
without mesh fixation does not appear to increase the incidence of hernia
recurrence. Mesh infection followed by recurrence were reported in three cases
of the (mesh fixation) group; it seems that propability of mesh infection
increased with tackers with multi-use handle used in our country.Mesh infection
was most propably the cause of recurrence in our study. Transabdominal
preperitoneal hernia repair with fixation increase cost which is important in
developing countries.