Totally extraperitoneal repair of XXXX : A case for bilateral repair.

@entity1 @entity169 @entity1413 @entity547
@entity169 has been one of the most extensively debated and continues to evolve in search for the ideal technique. Even though the method to diagnose @entity547 has largely remained clinical, recently other modalities have detected @entity547 that are not picked up on clinical examination or are incorrectly labeled. Laparoscopy, for the first time has given surgeons the unique opportunity to look at both sides of the groin and to detect and study the contra lateral groin in a @entity1 of clinically unilateral @entity547 . This has given rise to some interesting findings. In the pediatric age group the value of bilateral detection and repair has been extensively debated. However, the same is not true for the adults despite the facts that there are better methods for detection, better understanding of pathogenesis of @entity547 and better repair techniques that can take care of bilateral repair without adding to morbidity.That @entity547 is not a simple derivative of patent processus vaginalis or strain related cause is beginning to be better understood now. It may primarily be a disorder of collagen metabolism with genetic basis. Laparoscopy has also made us wiser in detection of type of @entity547 and examination of both groin areas. In several studies there have been a high percentage of undetected @entity547 or additional defects. This was never realized earlier as in open surgery there is no question of exploring the asymptomatic groin. Laparoscopy in bilateral repair is safe and does not add significantly to the operating time, cost or morbidity.At our Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India we have been performing Endoscopic Totally Extraperitoneal (TEP) repair for all simple and complicated @entity169 since 1994. We now routinely perform a bilateral repair based on our understanding that the pathogenesis of @entity547 is a complex process and any genetic basis of @entity1413 has to affect the @entity1 bilaterally. The clinical examination may have unacceptably low sensitivity. Early identification and repair obviates the need for reoperation, reduces overall costs and eliminates further anaesthetic and operative risks for the @entity1 .
