,

1 ,
2 ,

,
, .
,
,

.

,


.



.


.

.

.
2 ,
800 (1). (
) .

 ( )

(2 , 3 ) ,

.
( 1,8%
3,5% )
(4 , 5 , 6 ).
.
(10),
.




.

?

:
. TAPP ( transabdominal preperitoneal)
. TEP (totlly extraperitoneal)
. IPOM (intraperitoneal onlay mesh)
IPOM (intraperitoneal onlay mesh)
.
,
.
.
TEP (totlly extraperitoneal)
, (
)
.
,
250 .

 , , TAPP
.
TAPP
(
transabdominal
preperitoneal)

,
.
, 25
.
.
TEP (totlly extraperitoneal) TAPP ( transabdominal preperitoneal)
.(4, 6, 7)

( )
.
.(8, 9)

:
( median)
;
,
; ,
.

 . ,
( ),
(
)
, ,
.( 11,
12) .


( myopectineal orifice) Fruchaud .(11)


,
,
( pectin ossis pubis
Cooper- ) .

,
,
. Fruchaud

.

,

.

.
.

. ( Triangle of pain)
,
.
.
( Triangle of doom)

.
.( 12, 13)

TAPP
( transabdominal preperitoneal) TEP ( totally extraperitoneal )
. ( 14)

.
,

TAPP ( transabdominal preperitoneal
) .

( )
.(15)
Trendelenburg- 10.
, 10 ( ),
. ,
. , ,

( 12 Hg ).

Veres-
.
5
(
).

,
,
. .

3-4.
,
.
,
.

1
, 2

, 3

, 4


10-15
3 .
r .

.
( ).
.
( 11, 15 )



:
Wright et al. 1996 ;Collaboration EH , 2000 ;Sarli et al. , 1997; Schrenk et al. , 1996;
Vogt et al. , 1995
IPOM
6%
TAPP (n = 1896)
2%
TEP (n = 911)
2.6%

TEP ( 14 )
, ,
.


.
5 (5) ,
11% 21.7% 1.9 % 3.5%
.
4.5% 3%
, 1%
.
.
,
. ( 4, 6, 7, 10 ).
,
.(10)

Cunningham et al. ,1996: 315

Johansson et al. , 1999 : 613

/


.

10%
1%
2.8%
*

2.5%
0.5 to 4.9%

0.5%

0.5%

0.5%

0.5%

0.5%

0.5%

.


.

.
,
.



.

1. Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the

United States in 2003. Surg Clin North Am. Oct 2003;83(5):1045-51, v-vi
2. Lichtenstein IL, Shulman AG. Ambulatory outpatient hernia surgery.
Including a new concept, introducing tension-free repair. Int Surg. 1986 JanMar;71(1):14.
3. Kark AE, Kurzer M, Waters KJ. Tension-free mesh hernia repair: review of
1098 cases using local anaesthesia in a day unit. Ann R Coll Surg Engl. Jul
1995;77(4):299-304.

4. Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ.
Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic
review. Surg Endosc. Feb 2007;21(2):161-6.
5. [Best Evidence] Eklund A, Montgomery A, Bergkvist L, Rudberg C. Chronic
pain 5 years after randomized comparison of laparoscopic and Lichtenstein
inguinal hernia repair. Br J Surg. Apr 2010;97(4):600-8.

6. Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D,

Gibbs J, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia.
N Engl J Med. Apr 29 2004;350(18):1819-27.
7. Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis
of randomized clinical trials comparing open and laparoscopic inguinal hernia
repair. Br J Surg. Dec 2003;90(12):1479-92
8. Brick WG, Colborn GL, Gadacz TR, Skandalakis JE. Crucial anatomic lessons
for laparoscopic herniorrhaphy. Am Surg. Feb 1995;61(2):172-7
9. Vidovic D, Kirac I, Glavan E, et al. Laparoscopic totally extraperitoneal
hernia repair versus open Lichtenstein hernia repair: results and complications.
J Laparoendosc Adv Surg Tech A. Oct 2007;17(5):585-90
10. McCormack K; Wake B; Perez J; Fraser C; Cook J; McIntosh E; Vale L;
Grant AHealth Services Research Unit, Institute of Applied Health Sciences,
University of Aberdeen, UK . Laparoscopic surgery for inguinal hernia repair:
Systematic review for effectivness and economic evaluation Health Techol
Assess. 2005 9(14):1-203, iii-iv (ISSN :1366-5278)
11. F. Charles Brunicardi ( Editor). Schwartzs Principles of surgery, eighth
edition, McGraw- Hill. 2009
12. Skandalakis JE, Skandalakis PN, Skandalakis LJ (Editors). Surgical anatomy
and technique: a pocket manual. 2nd ed. New York: Springer; 2000.
13. 'Malley KJ, Monkhouse WS, Qureshi MA, Bouchier-Hayes DJ. Anatomy of
the peritoneal aspect of the deep inguinal ring: implications for laparoscopic
inguinal herniorrhaphy. Clin Anat. 1997;10(5):313-7.
14. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM.
Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP)
laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst
Rev. Jan 25 2005;CD004703.
15. Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Prophylactic antibiotics
for mesh inguinal hernioplasty: a meta-analysis. Ann Surg. Mar
2007;245(3):392-6.

16. Danny A Sherwinter MD, Chief, Associate Program Director, Department

of Minimally Invasive and Bariatric Surgery, Maimonides Medical Center .
Laparoscopic inguinal hernia repair ( Medscape)