Laparoscopic Transabdominal Preperitoneal For Recurrent Inguinal Hernia: A Randomized Trial

1-The laparoscopic transabdominal preperitoneal repair (TAPP): The hernia defect was inspected. The properitoneal space was dissected from lateral to medial at the level of the retroinguinal (Bogros') space, with parietalization of the spermatic cord posteriorly and outwards. The dissection was continued medially towards the retropubic space, extending behind the symphysis pubis and iliopubic tract, exposing the pectineal ligament. The peritoneum forming the hernia sac was pulled in, separating it from the cord structures. A 15 x 10 cm sheet of polypropylene mesh was placed so as to cover the Hesselbach's triangle, the indirect space, and the femoral ring areas. The mesh was fixed using an endoscopic multifire hernia stapler. The mean operative time was 122.5 minutes (80-170). 2- The open preperitoneal approach to the inguinal region was performed under general or regional anesthesia, as originally described by Nyhus . Through a lower abdominal transverse incision, the anterior rectus sheath was incised and the rectus muscle reflected medially. The preperitoneal space was cleaved with blunt dissection, exposing the myopectineal orifice. The cord was explored and the hernias were reduced. A 15x15 cm polypropylene mesh with a slit was inserted in the preperitoneal space and fixed with nonabsorbable sutures to pubic tubercle and Cooper's ligament. The mesh was passed behind the cord and manipulated to lay flat against the posterior inguinal floor overlapping the entire myopectineal orifice. The mean operative time was 71.6 minutes (40–120).