TEP RELEASE & REINFORCE TECHNIQUE

TEP RELEASE & REINFORCE TECHNIQUE FOR SPORTSMAN HERNIA

.Moshe Dudai MD FACS; Hernia Excellence, Tel Aviv Israel

At 1986 we upgraded our technique for Sportsman Hernia (SH) to TEP with releasing of the Inguinal ligament (IL). At 1998 independently, David Lloyd add the IL release to his TAPP technique. We will describe our Release & Reinforce Technique (RRT).

Background; The pathologies of SH are in the Posterior Wall (PW), Conjoint Tendon and Inguinal Ligament. Consequence of that, a High Pressure be created in the Inguinal Canal (IC) and on the Genito and Femoral Nerves (entrapment) during Sport Activities (SA). The aim of the SH surgical repair is to release those pressures and reinforcing the PW.

Methods; In our RRT we combining Pressure Releasing with PW Reinforcing: Doing a vast release, one should reinforce the Groin. Reinforcing the Groin without releasing the pressure creators, the patient can remain with the pain during sport activity. The strained and inflamed IL creates pressure in the IC and on the Nerves behind it (entrapment); Genital and Femoral Nerves. Pressure can be created as well by herniation of Lipomas into injured opened anatomical Orifices. The PW deficiency leading to bulging during SA and increasing the pressure in the IC.

We use the TEP technique, SH is always bilateral. After wide Adhesiolysis and Extraction of any herniated Lipoma, we are Dividing the IL at the lateral aspect of the IR. For completing the procedure, we are Reinforcing the PW with wide light PPP mesh. The PPT is complemented by Athlete Rehabilitation Program

Discussion: The injured IL is a major factor of pressure creating in the IC and entrapping the Genital and Femoral Nerves behind it. Dividing the IL in addition to PW Reinforcing, add a great advantage for reliving pain during SA. RRT procedure leads to very good results of less than 0.5% persistent pain after returning to SA.

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