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Laparoscopic hernia repair

Inguinal hernias can be repaired via a laparoscopic approach, either across the peritoneal cavity (TAP), or via a totally extra-peritoneal approach (TEP). The latter is now favoured by most.

Laparoscopic repair has the advantge of placing the mesh behind the defect rather than infront as in open hernia repair. An analogy to a hole in a dam if sometimes drawn: If there was a small hole in a dam and you had only one plank to fix it, would you put it on the water side of the hole (where the plank would be placed against the hole by the weight of the water), or on the other side of the dam (where the pressure from the water would more easily push off your repair)?

There is a lower incidence of chronic pain after pre-peritoneal reapir as there nerves in the inguinal canal will not be damaged.

Laparoscopic repair may also facilitate a quicker return to normal activities.

However, laparoscopic repair may take longer to perform, especially early in the learning curve.

For details of the NICE guidelines on laparoscopic hernia repair click here (external link).

To see videos of TAP and TEP repairs click here (external link).

Developing a plane

A plane infront of the peritoneum and behind the posterior rectus sheath amd muscle is developed by blunt dissection

Dissecting an indirect sac

Unfurling the mesh

The deep ring, back wall of the inguinal canal and femoral canal are covered. The mesh lies infront of the peritoneum and behind the inguinal canal. Any increase in abdominal pressure pushes the mesh more firmly on to the back of the inguinal canal, stopping the escape of abdominal contents through a defect in the abdominal wall.

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