الفتق الصغير: عملية Ventral TAPP مقابل IPOM | Ventral TAPP vs. IPOM: Repairing Small Ventral Hernias
شبكة خارج الغشاء البريتوني | Mesh Outside the Peritoneum
في الفتق الصغير، عملية الـ Ventral TAPP من أسهل وأفضل طرق الإصلاح بالمنظار لمرضى كتير. د. محمد حسام زيدان بيشرح إنها بتشبه الـ IPOM+ في إن المنظار بيدخل تجويف البطن، لكن الجراح بيفتح طبقة الغشاء البريتوني ويحط الشبكة تحتها، فما بيبقاش فيه تلامس بين الشبكة والأمعاء، وده بيقلل الالتصاقات وبيسمح باستخدام شبكة أرخص، مع إصلاح جدار البطن نفسه. وبيذكر تحليل لـ 8 دراسات على فتق أقل من 4 سم: نسبة الرجوع 13.9% مع TAPP مقابل 23.9% مع IPOM+، وبيوضح إنها بتتختار للمريض اللي ما عندوش زيادة في الوزن. | For small ventral hernias, ventral TAPP is one of the simplest and best laparoscopic repairs for many patients. Dr. Mohamed H. Zidan explains that, like IPOM+, the laparoscope enters the abdominal cavity, but the surgeon opens the peritoneal layer and places the mesh beneath it, so the mesh does not touch the bowel. This reduces adhesions and allows a much cheaper mesh, while the abdominal wall itself is also repaired. He cites a pooled analysis of eight studies on hernias under 4 cm: recurrence of 13.9% with ventral TAPP versus 23.9% with IPOM+. He notes that this operation is chosen for patients who are not overweight.
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Full Transcript
Host: Doctor, what if the hernia is small?
Dr. Zidan: For small hernias we have several repair methods, including TAPP, which is the simplest and best for a great many patients. TAPP is both different from and somewhat similar to IPOM Plus; let me explain how. First, we also place the mesh from inside the abdominal cavity, but we open a layer to place a standard mesh beneath the peritoneum, so there's no contact between the mesh and the bowel. That reduces adhesions, and we can use a much cheaper mesh. Second, we repair the abdominal wall, which also lowers the recurrence rate. A pooled analysis of eight studies comparing IPOM Plus with TAPP showed a recurrence rate of 13.9% with ventral TAPP compared with 23.9% with IPOM Plus, but those studies were on hernias smaller than 4 cm. That tells us that choosing the right mesh and the right operation for the size of the hernia is the best way to choose the operation. But note that we choose this operation for patients who are not overweight.