This video demonstrate TAPP (Transabdominal Preperitoneal Inguinal Hernia) Repair by Ipsilateral Port. The indications for laparoscopic inguinal hernia repair, TAPP or TEP, are the same for open inguinal hernia repair. They may be ideal for bilateral inguinal hernias and recurrences from anterior approaches but is also appropriate with unilateral primary hernias when the surgeon is comfortable with the technique.

For young, active males with primary hernias, it may ofter decrease pain and an earlier return to activity. Prior to lower abdominal surgery or pelvic radiation is strong relative contraindications, as these may make access to the preperitoneal space difficult. The hernia is visualized, and the peritoneum overlying it incised sharply. Blunt dissection can be used to peel the peritoneal flaps inferiorly, exposing the inferior epigastric vessels, the pubic symphysis and Cooper’s ligament, and the iliopubic tract. A direct hernia should be reduced if seen, and an indirect dissected from the cord structures.

Femoral and obturator hernias can also be visualized and reduced. Care is taken to avoid the “Triangle of Doom” containing the external iliac vessels bordered by the vas deferens medially and the gonadal vessels laterally. A mesh ranging from 10 to 15 cm in diameter of polypropylene or polyester is introduced through the optical trocar and positioned anterior along the pelvic wall with the center over of the primary hernia defect.

Hernia repair has evolved dramatically over the past few decades, with laparoscopic techniques offering patients faster recovery, reduced postoperative pain, and lower recurrence rates compared to traditional open surgery. Among the laparoscopic approaches, Transabdominal Preperitoneal (TAPP) Hernia Repair stands out for its versatility and precision. A newer refinement, performing TAPP repair using an ipsilateral port, has further optimized surgical ergonomics and patient outcomes.

Understanding TAPP Hernia Repair

TAPP Hernia Repair is a minimally invasive technique where the surgeon accesses the preperitoneal space via the abdominal cavity to place a mesh over the hernia defect. Unlike open repair, TAPP allows direct visualization of both sides of the groin, making it particularly effective for bilateral hernias or recurrent cases. The procedure involves:

1. Creating a pneumoperitoneum for clear visualization.

2. Making a peritoneal incision above the hernia defect.

3. Dissecting the preperitoneal space to expose the hernia sac.

4. Reducing the hernia sac and preparing the defect for mesh placement.

5. Placing a synthetic mesh to reinforce the abdominal wall.

6. Closing the peritoneum to prevent adhesions.

Ipsilateral Port Technique: Innovation in Ergonomics

Traditionally, TAPP repair uses contralateral or midline port placement, which sometimes requires awkward instrument angles, especially in large or complex hernias. Ipsilateral port placement—positioning the working port on the same side as the hernia—offers several advantages:

• Enhanced Instrument Control: Aligning the port ipsilaterally reduces crossing of instruments, providing a more natural hand-eye coordination for the surgeon.

• Reduced Operating Time: Streamlined movements often lead to faster dissection and mesh placement.

• Improved Ergonomics: Less strain on the surgeon’s shoulders and wrists contributes to better precision, especially in lengthy procedures.

• Optimal Mesh Placement: The direct angle facilitates accurate and secure positioning of the mesh, reducing the risk of recurrence.

Indications and Patient Selection

The ipsilateral port TAPP technique is particularly useful in:

• Unilateral inguinal hernias

• Recurrent hernias after open repair

• Large or complex hernias requiring precise mesh placement

It is essential that patients undergo preoperative imaging or clinical assessment to confirm suitability. Surgeons must be proficient in laparoscopic anatomy, as the ipsilateral approach requires careful navigation of the inferior epigastric vessels and vas deferens.

Surgical Technique Highlights

1. Port Placement:

   • A 10–12 mm camera port is typically placed at the umbilicus.

   • A working port of 5–10 mm is positioned ipsilateral to the hernia, just above or below the McBurney point.

   • An assistant port may be used on the contralateral side if needed.

2. Dissection:

   • The peritoneum is incised from lateral to medial, creating a preperitoneal flap.

   • Care is taken to preserve critical structures such as spermatic cord, epigastric vessels, and nerves.

3. Mesh Placement and Fixation:

   • A lightweight polypropylene mesh is deployed over the myopectineal orifice.

   • Fixation is often achieved with tacks or self-fixating mesh, minimizing the risk of nerve entrapment.

4. Peritoneal Closure:

   • The peritoneum is meticulously closed to prevent adhesions.

   • Ipsilateral port access allows seamless closure without undue tension.

Benefits of Ipsilateral Port TAPP

• Reduced postoperative pain due to minimized instrument manipulation.

• Faster recovery and return to daily activities.

• Lower recurrence rates due to precise mesh placement.

• Improved surgeon comfort, translating to safer and more consistent outcomes.

Conclusion

The ipsilateral port approach in TAPP hernia repair represents a significant step forward in laparoscopic surgery, combining the advantages of minimally invasive techniques with ergonomic efficiency. As surgeons gain familiarity with this method, patients benefit from shorter operative times, quicker recovery, and superior functional outcomes.