TMR surgical method
Indications and contraindications
Indications: midline anterior abdominal wall incisional hernia between the xiphoid and umbilicus, with a maximum width of 9 cm in rest position (seen on CT Scan).
Contraindications: pregnant women, cancer patients, patients who had regained significant weight or had clinical contraindications to the proposed method.
Differentiation from open repairs
- Shorter hospital stay (1.2 X 4 days)
- Less pain
- Minimal scars
- Better Quality of life
- Faster recovery
- Faster return to “normal” life
- Aesthetic procedure
Summary of the advantages of the TMR technique
- Laparoscopy
- Abdominal wall reconstruction
- Abdominal function
- Short hospital stay
- Low pain
Pros and Cons:
PROS:
Reduced length of time in hospital, better postoperative outcomes, lower infection risk, smaller incisions and less pain. It also avoids large dissections and muscular lesions, especially in the incisional hernia, as well as avoiding the need for external drains and larger meshes. Finally, it avoids the use of restrictive dressings with the related skin reactions and complications. The examination of the abdominal cavity by laparoscopy allows a better understanding of the hernia’s condition or other problems that could be not seen using the conventional approach.
CONS:
Adhesions between the bowels and the formation of intra peritoneal scars that might restrict access and/or the production of a single cavity and adequate workspace against the anterior abdominal wall. Therefore, indication of laparoscopy depends on understanding the patient’s abdominal condition, if it is possible to proceed with adhesionlysis in a good and effective manner which could facilitate the placement of the mesh and the closure of the defect.
Pre-operative evaluation
- Physical Examination (Abb. Physical Examinations
- CT Scan (Abb. tc pre 1 + sagital pre)
- Clinical evaluation
- Anesthetic evaluation
