Open Pre Peritoneal Prothesis: Trans Inguinal Pre Peritoneal Technique (TIPP), Minimal Open Pre Peritoneal Technique, Ugahary Technique
Seance of wednesday 21 november 2018 (Chirurgie de la paroi abdominale)
DOI number : 10.26299/vske-a712/emem.2018.1.008
Abstract
According to the principles developed by L. Nyhus, J. Rives and R. Stoppa, with the contributions of JH Alexandre and B. Kron, F Ugahary described a minimally invasive technique for the treatment of the groin hernias (under local anesthesia and ambulatory sitting ...) by a 3 cm inguinal incision located 3 cm above the deep inguinal ring. with the placement of a non-fixed large pre-peritoneal prosthesis. The extensive release of the cleavable spaces and the parietalization of the spermatic cord being performed using "dissecting" valves.
The design by E. Pélissier of a specific prosthetic material, allowed the development of a same type of intervention with the same principles but with an incision at the level of the deep inguinal ring orifice It is the Trans Inguinale Pre-Peritoneal (TIPP). E. Pelissier, P. Ngo. F. Berrevoet, S. De Gendt. J.F. Gillion and J.M. Chollet were the initiators and promoters of the TIPP technique.
Using the F. Ugahary's principles of dissection with the approach of the TIPP technique, I proposed a minimal invasive technique (the minimal open peritoneal technique, MOPP), with a smaller (3 to 4) incision. The main principle is always to put a large not fixed prosthesis in the preperitoneal space with parietalization of the spermatic cord. All types of primary inguinal or crural hernia can be treated by this technique, in Particularly large inguino-scrotal hernias or incarcerated crurales hernias. In the presence of bilateral hernia, both sides are operated during the same operative session, the two prostheses are superimposed on the median line. Recurrent hernias without material in the preperitoneal space, or after Lichtenstein technique are also an excellent indication for the MOPP technique. Radical prostatic surgery, pelvic radiotherapy, pre or retro vascular bypass are a contraindication to the MOPP / TIPP technique, as well as recurrent hernias with prosthesis implanted in the pre-peritoneal space. However, with experience, it is often possible to perform a MOPP / TIPP-type approach, and finally to decide to perform a Lichtenstein type intervention in case of dissection failure in the peritoneal plane. The procedure is usually performed in day surgery according to the usual criteria and with the precautions of use. There are no special restrictions regarding post-operative authorized activities
The design by E. Pélissier of a specific prosthetic material, allowed the development of a same type of intervention with the same principles but with an incision at the level of the deep inguinal ring orifice It is the Trans Inguinale Pre-Peritoneal (TIPP). E. Pelissier, P. Ngo. F. Berrevoet, S. De Gendt. J.F. Gillion and J.M. Chollet were the initiators and promoters of the TIPP technique.
Using the F. Ugahary's principles of dissection with the approach of the TIPP technique, I proposed a minimal invasive technique (the minimal open peritoneal technique, MOPP), with a smaller (3 to 4) incision. The main principle is always to put a large not fixed prosthesis in the preperitoneal space with parietalization of the spermatic cord. All types of primary inguinal or crural hernia can be treated by this technique, in Particularly large inguino-scrotal hernias or incarcerated crurales hernias. In the presence of bilateral hernia, both sides are operated during the same operative session, the two prostheses are superimposed on the median line. Recurrent hernias without material in the preperitoneal space, or after Lichtenstein technique are also an excellent indication for the MOPP technique. Radical prostatic surgery, pelvic radiotherapy, pre or retro vascular bypass are a contraindication to the MOPP / TIPP technique, as well as recurrent hernias with prosthesis implanted in the pre-peritoneal space. However, with experience, it is often possible to perform a MOPP / TIPP-type approach, and finally to decide to perform a Lichtenstein type intervention in case of dissection failure in the peritoneal plane. The procedure is usually performed in day surgery according to the usual criteria and with the precautions of use. There are no special restrictions regarding post-operative authorized activities