Transabdominal preperitoneal patch (TAPP) repair of inguinal hernia

Buttressing the posterior wall of the inguinal canal by laparoscopic insertion of a preperitoneal synthetic or biological mesh.

Make a periumbilical skin incision of about 1 cm. Insert the Verres needle through this incision and accomplish pneumoperitoneum. In case of previous surgery, insert the trocar for the camera through a blunt minilaparotomy.

After access to the abdominal cavity with the scissors, bluntly insert the trocar (10 mm) for the camera into the abdominal cavity and perform the initial inspection. At about the lateral level of the umbilicus insert a 5 mm trocar on the contralateral side of the hernia, while the ipsilateral side requires either a 5 mm or 10 mm trocar.

Tip: The 30°/45° laparoscope with the camera should face anteriorly. This allows the surgeon to survey the posterior wall of the inguinal canal.

Carefully free any adhesions with the scissors. If necessary, atraumatically clear any intestine and omentum from the hernia sac with graspers.

Transect the peritoneum in curved fashion superior to the hernia orifice from the medial umbilical fold to several centimeters lateral to the deep inguinal ring. Medial to the epigastric vessels, dissect between the bladder (Caution: Bladder injury!) and the posterior wall of the rectum up to the pectineal ligament (Cooper) and expose the symphysis. Now bluntly free the peritoneum caudad off the epigastric vessels, spermatic duct and the vessels of the spermatic cord.

Tip: Start the incision well superior to the deep inguinal ring or well away from the hernia sac respectively.