20 th international laparoscopic surgery symposium , January 24, 25, 26, 2013 S. F. C. E. 2013 MEETING Inguinal hernia repair: Minimal open preperitoneal approach: MOPP (Grid iron- TIPP techniques)

Marc Soler, Cagnes sur Mer – France

Henri R Fruchaud, 1956

 The surgical treatment of inguinal or femoral hernias must not be the closure of the inguinal canal or the femoral ring, but the « deep reconstruction » of the abdominal wall in the whole groin region  Surgical Anatomie of groin hernia Surgical treatment of groin hernia

The Nyhus Preperitoneal Repair, 1955-1960

1965 JEAN

Rives

René Stoppa

Giant prosthetic reinforcement of the viscéral sac 1967: First tension free and sutureless hernia repair

1992

Transperitoneal approach J. Leroy, G. Fromont Properitoneal approach G. Begin, JL Dulucq Mini-invasive ACCESS surgery But not minimale invasive surgery - general anesthesia -technique is complex -high cost of instrumentation -vascular and visceral complications

J.H. ALEXANDRE 1981 -

INGUINAL APPROACH -CORD PARIETALISATION - M. P. O. OVERLAPPING

Grid iron: Franz Ugahary 1995

TIPP: 2005

Edouard Pélissier

4. Pélissier Hernia. 2001 5. Pélissier Hernia. 2006

TIPP 2005

scrotal « approach » 6. Berrevoët et al. Hernia. 2009

TIPP TECHNIQUE

J.F. Gillion

TECHNIQUE MOPP- UGAHARY

TECHNIQUE MOPP-TIPP

TECHNIQUE MOPP-TIPP

SPECIFIC MATERIAL

Marc Soler: Cagnes sur mer From 2001 To 2012:N =1675 (1450 patients)

- 2001 TO 2009: regular flat mesh, and Light weight meshes: 1375 cases Ugahary (GRID IRON ) -2009 TO 2011: New expandable mesh: 200 cases Ugahary, (Grid Iron) - 2011:New mesh TIPP technique and grid iron: 200 cases

MINIMALE PREPERITONEALE TECHNIQUE (MOPP)

J.H. ALEXANDRE UGAHARY (GRID IRON TECHNIQUE) TIPP ( Trans Inguinale PrePeritoneale technique)

MOPP TECHNIQUE Conclusion

  

Total groin hernia repair primary & secondary hernia

Minimal invasive   Minimal access Local anesthesia, Complication  no conversion

Conclusion

 Surgical Technique No nerves dissection No prosthesis on the contact of the nerves No material to fix the prosthesis

MOPP TECHNIQUE Conclusion

The self expandable mesh, Make easier to unroll the prosthesis in the Preperitoneal space.

PROSPECTIVE STUDY - Post operative pain/ QOL - recurrence rate

Conclusion SURGEON

Hernia dedicated knowledge of preperitoneal anatomy surgical training

INSTRUMENTATION

regular surgical instruments long anatomical forceps a pair of small long blade, curved base retractors

MESH

Polypropylen mesh, large size

WHY TO CHOOSE POSTERIOR APPROACH ?

BECAUSE WE HAVE LESS SEVERE CHRONIC PAIN