Laparoscopic repair of inguinal hernia is a minimally invasive, tension-free technique that offers less pain, quicker recovery, and the ability to evaluate both groins. The two common laparoscopic approaches are TAPP (TransAbdominal PrePeritoneal) and TEP (Totally ExtraPeritoneal). Below is a clear, step-by-step guide covering preop, intraop sequence, and postop care, highlighting differences between TAPP and TEP where relevant.

Preoperative preparation

Confirm diagnosis clinically and with ultrasound / CT if atypical or recurrent.

Routine labs, anaesthetic assessment and informed consent (discuss mesh, fixation, risks).

Nil by mouth, prophylactic IV antibiotics per protocol, and thromboprophylaxis as indicated.

Catheterize if needed (large or incarcerated hernia) and ensure bladder empty at start.

Anesthesia & positioning

General anesthesia with muscle relaxation.

Supine position with slight Trendelenburg to let bowel fall cephalad.

Surgeon stands on the side opposite the hernia (or between legs for bilateral), assistant opposite; monitor at foot.

Port placement & access

TAPP:

Create pneumoperitoneum (Veress or open).

Insert 10 mm umbilical camera port, then two 5 mm working ports in the lower abdomen (usually mid-clavicular lines).

TEP:

Make infra-umbilical incision, develop preperitoneal space with balloon or blunt dissection, insert 10 mm preperitoneal camera port; two 5 mm working ports placed in midline (suprapubic and mid-lower abdomen).

Maintain insufflation in preperitoneal space (8–12 mmHg).

Diagnostic inspection (TAPP)

Survey both groins and abdomen; note contralateral occult hernia. (TEP inspects preperitoneal space directly.)

Reduce sac and expose anatomy

Identify inferior epigastric vessels, pubic bone/Cooper’s ligament, vas deferens, spermatic vessels, and femoral canal.

Carefully dissect peritoneum (TAPP) or preperitoneal fat (TEP) to expose the myopectineal orifice.

Reduce hernia sac contents (omentum, bowel) cautiously—avoid excessive traction on cord structures. In large indirect sacs, perform high sac dissection and reduce sac back into abdomen or ligate if necessary.

Achieve hemostasis with bipolar energy—avoid blind cautery near nerves and vessels.

Create adequate space (parietalization)

Free the cord structures laterally so mesh will lie flat; clear Cooper’s ligament and expose the entire defect including direct, indirect and femoral spaces.

Mesh selection & sizing

Use a large flat mesh that covers the entire myopectineal orifice with at least 3–4 cm overlap beyond defect margins (commonly 10×15 cm or larger).

For TAPP/IPOM, use composite mesh with anti-adhesive surface if intraperitoneal exposure is possible; for TEP, standard lightweight polypropylene is typical.

Mesh placement & fixation

Insert mesh rolled through 10 mm port and unroll over the defect.

Fixation options: tackers (absorbable/nonabsorbable), transfascial sutures, fibrin glue, or no fixation (many surgeons fix selectively—small defects may not require fixation).

Place fixations carefully—avoid the “triangle of pain” (lateral to the deep ring) where nerves run, and the “triangle of doom” (medial to the vas) where large vessels are located.

Peritoneal closure (TAPP)

Close peritoneal flap securely with sutures or tacks to prevent mesh exposure to bowel. (TEP has no peritoneal opening; simply desufflate preperitoneal space.)

Desufflation, inspection & closure

Gradually desufflate while checking mesh lies flat and cord structures are not kinked.

Irrigate and ensure hemostasis.

Close fascial defect at 10 mm port to prevent port hernia; close skin.

Postoperative care

Early mobilization and oral intake as tolerated.

Analgesia (NSAIDs ± short opioids).

Discharge usually same day or 24 hours depending on recovery.

Avoid heavy lifting for 4–6 weeks.

Follow up for wound check and to assess for chronic pain or recurrence.

Complications to watch for

Bleeding (inferior epigastric or preperitoneal vessels), nerve injury → chronic pain, seroma/hematoma, urinary retention, visceral injury (bowel, bladder), mesh infection, recurrence.

Pearls & common pitfalls

Know the anatomy: identify inferior epigastrics, Cooper’s ligament, vas/vessels before cutting.

Don’t over-fix the mesh—avoid nerves.

Ensure adequate mesh overlap and flat placement to minimize recurrence.

In recurrent or scarred groins, consider IPOM or open approaches if anatomy is hostile.

Conclusion

Laparoscopic inguinal hernia repair (TAPP or TEP) is reproducible and offers excellent outcomes when performed with careful anatomy recognition, meticulous dissection, appropriate mesh selection, and thoughtful fixation. For trainees, practice in a stepwise manner and supervision during early cases is essential for safe results.