This video demonstrates Bilateral Inguinal Hernia Surgery Trans Abdominal Preperitoneal Repair by Dr. R.K. Mishra at World Laparoscopy Hospital. An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles of the inguinal region. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object. However, many hernias do not cause pain. In a laparoscopic inguinal hernia procedure requiring general anesthesia, the laparoscopic surgeon operates through several small incisions in your abdomen. The laparoscopic surgeon may use laparoscopic or robotic instruments to repair a bilateral inguinal hernia. A laparoscope is inserted into one incision. Guided by the camera, the laparoscopic surgeon inserts tiny instruments through other small incisions to repair the hernia using synthetic mesh. People who have a minimally invasive repair might have less discomfort and scarring after surgery and a quicker return to normal activities. Long-term results of laparoscopic and open hernia surgeries are comparable. Minimally invasive laparoscopic inguinal hernia surgery for bilateral hernia allows the laparoscopic surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after open hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral). As with open surgery, it may be a few weeks before you can get back to your usual activity level.

The Trans-Abdominal Preperitoneal (TAPP) repair is considered the masterclass approach for bilateral inguinal hernias. Unlike traditional open surgery, which would require two separate, large incisions in both groins, the TAPP technique allows a surgeon to repair both sides through the same three tiny "keyhole" punctures.

At World Laparoscopy Hospital (WLH), the TAPP procedure is refined using the principles of "tension-free" repair and the anatomical "Mishra’s Triangle" to ensure zero recurrence and minimal chronic pain.

The Anatomy of the TAPP Approach

In a TAPP repair, the surgeon enters the peritoneal cavity (the space where the organs sit) to reach the hernia from the inside. This provides a panoramic view of the entire "myopectineal orifice"—the weak area where all inguinal and femoral hernias occur.

1. Creating the Preperitoneal Flap

The hallmark of TAPP is the "peritoneal flap." The surgeon makes a horizontal incision in the lining of the abdominal wall (peritoneum) above the hernia site. This flap is peeled back to reveal the "preperitoneal space," where the actual repair happens.

2. Reduction of the Hernia Sac

Using atraumatic graspers, the surgeon gently pulls the protruding abdominal contents (usually fat or bowel) back into the abdomen. In bilateral cases, this is done sequentially for both the right and left sides.

3. Mesh Placement: The "Internal Wall"

At WLH, a large, lightweight Polypropylene Mesh (usually $15 \times 12 \text{ cm}$) is used for each side.

• Coverage: The mesh must cover all potential hernia sites: Indirect, Direct, and Femoral.

• Fixation: To prevent the mesh from moving, it is secured using "tackers" or, increasingly, fibrin glue or Mishra’s intracorporeal suturing to reduce the risk of nerve entrapment.

The "Triangle of Pain" and "Triangle of Doom"

One of the most critical aspects taught by Dr. R.K. Mishra at WLH is the strict avoidance of the "forbidden zones":

• Triangle of Doom: Contains the major iliac arteries and veins. No staples or tacks are ever placed here.

• Triangle of Pain: Contains important sensory nerves. Placing a tack here can lead to permanent post-operative groin pain.

By utilizing the TAPP approach, the surgeon has the visual clarity to stay well away from these structures, a level of safety that is difficult to achieve in open surgery.

Recovery and Outcomes

Because the mesh is placed behind the abdominal wall, the natural internal pressure of the abdomen actually helps keep the mesh in place. This allows for:

• Early Mobilization: Patients are encouraged to walk within hours of surgery.

• Minimal Restrictions: Most patients return to desk work in 3 days and light exercise in 2 weeks.

• Aesthetics: The three small scars are often virtually invisible after 6 months, hidden by the umbilicus and natural skin folds.

Conclusion

Bilateral Inguinal Hernia repair via the TAPP method at World Laparoscopy Hospital represents the pinnacle of hernia surgery. By combining a "bird's eye view" of the anatomy with the latest mesh technology, the procedure offers the most durable and least painful solution for patients suffering from double groins hernias.

For more information log on to: https://www.laparoscopyhospital.com/

World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA: +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE: +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA: +1 321 250 7653