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ficnaleheda eney jirto dad san isku jecel

2026-09-26 16:34:59

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🤴🏻🇨 /🇳 🇺 🇺 🇷 ✈︎🕷️🕸️ :

:saxibkeygiyow maxaa igu noqotey mis iyada waxay ahed dunideyda Side ku hali way adked balse adi lacag miye igu faneh [Teary eyed]iyadena waxan leh yahy waad I dhawacdi qalpigeyga nh waad qadatey[Teary eyed]ma hashi qofka saxda adi ku qalmih[Teary eyed]

2026-09-26 22:01:09

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LuQMaaN_الحكيم🫅🖤 :

@♡𝙎𝙪𝙣𝘿𝙪𝙨🩷🦢 dulufeyy👸🤍🫶

2026-09-26 19:31:09

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زاك🛸🪄 :

@Dajiya🤤🦢 my queen🌹🥰

2026-09-26 20:30:12

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@Haniyeta💕😋 Bestei 🫶😭🫂

2026-09-26 19:44:50

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@👸ayeeyo__koris800🔐 🥰😂

2026-09-26 16:30:19

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@SUمAي🦢🩷

2026-09-26 21:47:50

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Endoscopic inguinal hernia repair (TEP – totally extraperitoneal and TAPP – transabdominal preperitoneal) offers clear advantages, but also requires consideration of critical points for its success. Advantages (evidence-based benefits) 1. Less postoperative pain and faster recovery Multiple clinical trials and meta-analyses show that acute pain in the first few days is significantly less than with the open mesh technique (Lichtenstein). This translates into an earlier return to daily activities and work (average difference of 5-7 days). Evidence: Cochrane Review (McCormack et al.), trials such as the Eklund SMIL study, and the Bracale meta-analysis. 2. Lower incidence of chronic inguinal pain The rate of persistent pain (moderate-to-severe at 1 year) is lower, around 2-4% vs. 5-10% with open surgery. Dissection behind the transversus abdominis muscle preserves the sensory nerves of the region (ilioinguinal, iliohypogastric, genitofemoral) by not opening the inguinal canal. Evidence: HerniaSurge 2018 Guidelines (strong recommendation), EHS analysis. 3. Panoramic view and optimal treatment of bilateral and recurrent hernias Endoscopy allows exploration of both inguinal and femoral orifices without additional incisions. In bilateral hernias, simultaneous repair with three small incisions avoids two large open wounds, resulting in less pain and fewer wound complications. In recurrent hernias following previous open surgery, the posterior approach avoids anterior scar tissue, reducing the risk of spermatic cord injury and testicular atrophy. Evidence: Strong recommendation from HerniaSurge: the endoscopic approach is the first choice for primary bilateral inguinal hernias and for recurrent hernias following open repair. 4. Lower wound infection rate and abdominal wall complications Minimal incisions drastically reduce superficial infections (risk 3-4 times lower) and virtually eliminate large seromas and extensive open wound hematomas. Furthermore, the possibility of incisional hernia at the ports is very low (0.1-0.3%) when proper technique is used. 5. Improved identification and treatment of femoral hernias (especially in women) Direct visualization of the femoral ring from the preperitoneal space allows for the diagnosis and treatment of occult femoral hernias, which are common in women. Current evidence recommends the endoscopic approach for all women with inguinal hernias precisely because of this ability to provide comprehensive staging. Evidence: HerniaSurge strongly recommends the laparoscopic approach in women. 6. Similar long-term recurrence rate in experienced hands Although early recurrence may be slightly higher during the learning curve, with refined technique (wide dissection of the preperitoneal space, sufficiently sized mesh ≥10×15 cm, atraumatic fixation) 5-10 year results are equivalent to those of Lichtenstein (around 1-2%). Critical points to consider 1. Steep learning curve Endoscopic groin surgery is technically demanding. Between 50 and 100 supervised procedures are required to reach a plateau of competence, during which serious complications (vascular, visceral, recurrence) are highest. Risk: Higher rate of early recurrence and complications in inexperienced hands 2. Potentially catastrophic complications Although infrequent (0.1-0.5%), major vascular injuries (iliac vessels, deep epigastric vessels), bowel perforation (especially during TAPP insertion), bladder or ureteral injury can occur. These require immediate conversion to open surgery and open repair. Blind vascular injury with the trocar remains the most feared complication. 3. Need for general anesthesia Unlike open surgery, which can be performed with local anesthesia, endoscopy requires general anesthesia with muscle relaxation provided by the pneumoperitoneum and the working space. #mesh #hernioplastiainguinal #inguinalhernia

Endoscopic inguinal hernia repair (TEP – totally extraperitoneal and TAPP – transabdominal preperitoneal) offers clear advantages, but also requires consideration of critical points for its success. Advantages (evidence-based benefits) 1. Less postoperative pain and faster recovery Multiple clinical trials and meta-analyses show that acute pain in the first few days is significantly less than with the open mesh technique (Lichtenstein). This translates into an earlier return to daily activities and work (average difference of 5-7 days). Evidence: Cochrane Review (McCormack et al.), trials such as the Eklund SMIL study, and the Bracale meta-analysis. 2. Lower incidence of chronic inguinal pain The rate of persistent pain (moderate-to-severe at 1 year) is lower, around 2-4% vs. 5-10% with open surgery. Dissection behind the transversus abdominis muscle preserves the sensory nerves of the region (ilioinguinal, iliohypogastric, genitofemoral) by not opening the inguinal canal. Evidence: HerniaSurge 2018 Guidelines (strong recommendation), EHS analysis. 3. Panoramic view and optimal treatment of bilateral and recurrent hernias Endoscopy allows exploration of both inguinal and femoral orifices without additional incisions. In bilateral hernias, simultaneous repair with three small incisions avoids two large open wounds, resulting in less pain and fewer wound complications. In recurrent hernias following previous open surgery, the posterior approach avoids anterior scar tissue, reducing the risk of spermatic cord injury and testicular atrophy. Evidence: Strong recommendation from HerniaSurge: the endoscopic approach is the first choice for primary bilateral inguinal hernias and for recurrent hernias following open repair. 4. Lower wound infection rate and abdominal wall complications Minimal incisions drastically reduce superficial infections (risk 3-4 times lower) and virtually eliminate large seromas and extensive open wound hematomas. Furthermore, the possibility of incisional hernia at the ports is very low (0.1-0.3%) when proper technique is used. 5. Improved identification and treatment of femoral hernias (especially in women) Direct visualization of the femoral ring from the preperitoneal space allows for the diagnosis and treatment of occult femoral hernias, which are common in women. Current evidence recommends the endoscopic approach for all women with inguinal hernias precisely because of this ability to provide comprehensive staging. Evidence: HerniaSurge strongly recommends the laparoscopic approach in women. 6. Similar long-term recurrence rate in experienced hands Although early recurrence may be slightly higher during the learning curve, with refined technique (wide dissection of the preperitoneal space, sufficiently sized mesh ≥10×15 cm, atraumatic fixation) 5-10 year results are equivalent to those of Lichtenstein (around 1-2%). Critical points to consider 1. Steep learning curve Endoscopic groin surgery is technically demanding. Between 50 and 100 supervised procedures are required to reach a plateau of competence, during which serious complications (vascular, visceral, recurrence) are highest. Risk: Higher rate of early recurrence and complications in inexperienced hands 2. Potentially catastrophic complications Although infrequent (0.1-0.5%), major vascular injuries (iliac vessels, deep epigastric vessels), bowel perforation (especially during TAPP insertion), bladder or ureteral injury can occur. These require immediate conversion to open surgery and open repair. Blind vascular injury with the trocar remains the most feared complication. 3. Need for general anesthesia Unlike open surgery, which can be performed with local anesthesia, endoscopy requires general anesthesia with muscle relaxation provided by the pneumoperitoneum and the working space. #mesh #hernioplastiainguinal #inguinalhernia

Si un autre homme est capable d’être proche de ta femme ou ta petite amie ce n’est pas lui le problème

Si un autre homme est capable d’être proche de ta femme ou ta petite amie ce n’est pas lui le problème

Yao Khuwa Me Zra Belale Dai Bal Khuwa Sor Wor Dai Pashto Song Trending Song Viral Now 😔🎶💥🖤🎧✨🎼 #sadsong #viwesproblem #needsupport🥺 #growaccount #foryoupage

Yao Khuwa Me Zra Belale Dai Bal Khuwa Sor Wor Dai Pashto Song Trending Song Viral Now 😔🎶💥🖤🎧✨🎼 #sadsong #viwesproblem #needsupport🥺 #growaccount #foryoupage

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