الفهرس 
Anatomy of the Anterior Abdominal WallOnly 14 pages are availabe for public view
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Abstract
Laparoscopic herniorrhaphy is an excellent alternative to standard herniorrhaphy in selected patients. This procedure performed via the trans-abdominal or extra-peritoneal approach affords a repair with an equivalent and perhaps better recurrence rate than standard open techniques. Its disadvantages include the need for general anesthesia, its greater technical difficulty, its greater equipment requirement, and the need to enter the abdomen, at least for the trans-abdominal approach. Its advantage in permitting rapid post-operative recovery is most dramatic when compared to bilateral tissue repairs. It is also safer and easier in the context of a multiply recurrent hernia.
Laparoscopy offers an excellent exposure of the preperitoneal space that can be quite useful in repairing many hernias, especially those that are recurrent or otherwise complicated .A through understanding of the anatomy of the inguinal region and abdominal wall from the unique perspective of the laparoscopic surgeon is essential before a surgeon performs a laparoscopic hernia repair.
The¬ laparoscopic totally extra-peritoneal herniorrhaphy is preferred in patients with recurrent hernias, bilateral hernias, and unilateral hernias with a suspected contralateral hernia. Surgeons with out advanced laparoscopic skills or without the time to develop the skills necessary to perform laparoscopic herniorrhaphy should consider referring patients with recurrent hernias to surgeons with experience in totally extra-peritoneal. Trans-abdominal periperitoneal hernioplasty should be reserved for patients with prior lower abdominal incisions that make dissection of the peritoneum from the underside of the incision impossible.Also it is useful if another laparoscopic procedure is going to be done as laparoscopic cholecystectomy.
Patients who can’t tolerate general anesthesia, or who have had extensive lower abdominal surgery shouldn’t undergo laparoscopic herniorrhaphy. Patients with recurrences following laparoscopic hernioplasty are better repaired through undisturbed tissue by an anterior approach.
Laparoscopic ventral hernia repair is a very successful procdure that is gaing popularity and is very likely to become the standard of care in the future .Its advantages includes reduction in wound related morbidity associated with open technique, identification of swiss cheese hernia defects and occult hernias.
The majority of repairs are performed with the use of ePTFE patch,trabsfacial sutures and additional metal or absorbable fixation devices.These methods decrease the rate of recurrence .The most difficult portion of the operation is is the lysis of the adhesions that can result in an enterotomy. So laparoscopic repair of ventral hernias is a valuable approach for repair of abdominal wall defects in skilled hands, performed appropriately with safe adhesiolysis and adequate mesh placement, excellent long term results are possible.