الفهرس 
Definition and Pathophysiology of Inguinal HerniaOnly 14 pages are availabe for public view
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Abstract
Groin hernia repair is considered to be one of the most commonly performed operations by general surgeons however; there is no ”gold standard” operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities.
The laparoscopic revolution has raised a vigorous debate over the safest and most effective inguinal hernia repair. This debate has expanded our understanding of inguinal anatomy and hernia repair. At least, surgeons should be aware of the current indications and contraindications for laparoscopic inguinal hernia repair, because some hernias should have a laparoscopic repair. To increase effectiveness, surgeons should consider becoming skilled at both techniques, with the understanding that outcomes are optimal if one is committed to achieving fluency in laparoscopic repair.
Laparoscopic repairs also provide very good results where surgeons have expertise in the technique. It results in very low postoperative pain, fewer wound infection, and rapid return to daily activity and working where a mesh is placed either with a total extraperitoneal technique (TEP) or a transabdominal preperitoneal approach (TAPP).TAPP repair of inguinal hernia is an operation that is ideally suited to the Day Surgery Unit. It is associated with low rates of immediate post-operative complications and need for overnight stay, and can be performed in less time than is required for open repair.
The longstanding standard practice for TAPP was to use mesh fixation with tackers to prevent recurrence but atraumatic mesh fixation methods by using self -gripping meshes(Progrip) are being increasingly employed to prevent chronic pain in the wake of traumatic fixation methods.
Other current surgical options for mesh fixation include sutures and fibrin or other glues. However, there is no consensus on the best surgical technique and the choice of options often depends on surgeons‘ personal preference.
Based on our prospective randomized study, a few preliminary conclusions can be made. There was no significant difference in operative time between patients who underwent self gripping mesh fixation and those who underwent mesh fixation by absorpable tacks in TAPP reapir.
The postoperative pain assessment at 1 week, 4 weeks and 3 months shows that no significant difference between the two groups confirming the atraumatic nature of the self gripping mesh.We found that both surgical approaches had almost the same Postoperative Hospital stay where the mean postoperative hospital stay was 1.5 days versus 1.6 days in group A and group B, respectively and all patients returned to normal activity with mean time 7 ± 2versus 8 ± 2days in group A and group B respectively.
We found that no statistically difference as regard the recurrence between the use of Self Gripping mesh versus fixation of by absorpable tacks.
Our study demonstrates that laparoscopic inguinal hernia repair using the TAPP technique with implantation of a new Parietex™ ProGrip™ laparoscopic self-fixation mesh is a fast, effective and reliable method in experienced hands, which combines the advantages of laparoscopic approach with simple and practical implantation of self-fixation mesh, which, according to our results, reduces the occurrence of chronic pain and the recurrence rate.
In conclusion, after this comparative study, both the use of SGM and fixation of mesh by absorpable tacks approaches are similarly effective in terms of operative time, the incidence of recurrence, complications and chronic pain coinciding with all the available literature.