The first laparoscopic hernia repair was performed prior to laparoscopic cholecystec-tomy, yet has not supplanted open hernia repair, as has laparoscopic cholecystectomy for gallbladder disease. Reasons may include a steeper learning curve, an assumed increased operative cost, and the excellent alternative in open hernia repair. Ger in 1982 reported on 13 patients undergoing hernia repair, using a stapling device; the 13th patient underwent a laparoscopic repair (1). This early technique used a stapling device to close the neck of the hernia as the sole repair. Since then various techniques have been devised for laparoscopic herniorrhaphy. The initial approach consisting of simple ring closure had a high failure, because the deeper tissues were not approximated. This evolved to the necessity of a prosthetic biomaterial to reinforce the defect. Bogojavalensky first introduced hernia repair using a biomaterial in 1989 (2). At that time, a rolled piece of polyprolene mesh was placed into the indirect space of the hernia. Preliminary reports of this technique were promising, but long-term follow-up revealed a recurrence rate of 15% to 20%, leading to abandonment of such technique. Subsequently, the plug-and-patch and then the development of the intraperitoneal onlay mesh followed.

The intraperitoneal onlay mesh technique consisted of a large piece of biomaterial placed intra-abdominally to cover the peritoneum with a fixation device (3,4). This technique involved no dissection and was simple to perform, but led to a high failure rate for a number of reasons. The mesh would slip into the hernia defect, leading to adhesions with the bowel and also potential erosion into the bowel. Therefore, proper fixation of the mesh to the fascia of the transversalis muscle was deemed necessary to prevent this high failure rate and led to the development of the current transabdominal preperitoneal repair. Schultz et al. were the first to report on this technique, which involves dissection of the preperitoneal space and then fixation of a mesh to reinforce the defect (5). A later modification of this technique consisted of totally extraperitoneal approach, which involves balloon dissection into the preperitoneal space and avoids entering the abdomen (6). The totally extraperitoneal repair also incorporates a biomaterial mesh to repair the hernia with and sometimes without a fixation device.

Transabdominal preperitoneal and totally extraperitoneal approaches are the current modalities used in laparoscopic herniorrhaphy.

Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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