5. GI Reconstruction

Commonly, the GI reconstruction is carried out in the form of gastric bypass

Multiple operative techniques for inguinal hernia repair exist and can be catego­rized by anterior versus posterior approaches, each with mesh and non-mesh options. MI IHR is typically synonymous with posterior mesh approaches and has demon­strated advantages over open repair techniques including decreased postoperative and chronic pain as well as quicker return to normal activities [7]. MI IHR has been suggested as the preferred approach in primary unilateral groin hernias in males, bilateral inguinal hernias, femoral hernias, and women given their high incidence of femoral hernias [8]. As MI IHR typically refers to a posterior mesh approach, it is the method of choice for managing inguinal hernia recurrences following an open ante­rior approach. The most common types of MI IHR include the transabdominal pre­peritoneal (TAPP) and the totally extraperitoneal (TEP) approaches. The TAPP approach typically has a shorter learning curve than TEP and has other advantages such as the ability to rapidly assess the contralateral groin for a concomitant hernia and visualization of structure both above and below the peritoneal ap to prevent injury to underlying intra-abdominal viscera. Advantages for the TEP approach include the ability to avoid the intraperitoneal space and obviating the need for peri­toneal ap closure. However, TEP can be cumbersome due to limited working space and closely placed trocars. This can be further complicated with docking of the robotic platform. In addition, the ease of robotic suturing lessens the advantage of minimal suturing in TEP versus TAPP. Contraindications to MI IHR include inability to tolerate general anesthesia or pneumoperitoneum, severe ascites, strangulated her­nia with concurrent sepsis, and extensive intra-abdominal adhesions. History of pre­vious pelvic surgery such as prostatectomy may also deter one from selective minimally invasive approach.

Recently, the critical view of the myopectineal orice (CV of the MPO) was developed using best practices to standardize the dissection performed during MI IHR [10]. The following steps must be achieved but may be performed in any order: