What are the contraindications for transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Absolute contraindications for TAPP repair are few. In general, the inability to tolerate general anesthesia is considered an absolute contraindication, though there are reports of spinal anesthesia being used for this procedure. [50, 51] Other absolute contraindications are coagulopathy (because bleeding in the preperitoneal space can be difficult to assess and control postoperatively) and intra-abdominal infections that limit the use of prosthetic meshes.

Relative contraindications include previous abdominal surgery, especially pelvic surgery, and depend on the type and degree of expected adhesions, the surgeon’s level of comfort with adhesiolysis, and the nature of the hernia.

Previous prostate surgery was once thought to be an absolute contraindication, in that it would necessarily have disrupted the preperitoneal space. With improvement in techniques and familiarity with the TAPP procedure, previous prostate surgery is now considered a relative contraindication, and TAPP has been shown to be safe in this setting. [52] However, surgeons should be aware that TAPP repairs in patients who have undergone prostatectomy are more difficult and carry a higher morbidity.

Large inguinoscrotal hernias, though not a contraindication, can be challenging to manage because reducing these indirect sacs laparoscopically can be difficult. Patients with such hernias, especially when being operated on by an inexperienced surgeon, may be better served by an open approach.

It is important for surgeons to weigh the risks and benefits of TAPP repair against those of open repair. Thorough knowledge of the proposed benefits, indications, and contraindications of TAPP repair as compared with TEP and open repairs is essential and will help the surgeon tailor the surgical approach to the individual patient and the particular clinical scenario.

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