This video demonstrates Step by Step demonstration of Inguinal Hernia Surgery by Laparoscopy performed by Dr. R K Mishra at World Laparoscopy Hospital. Laparoscopic inguinal hernia repair is performed with general anesthesia. Two 5mm and one 10mm incision are made in the lower part of the abdomen. In laparoscopic inguinal hernia repair, a camera called a laparoscope is inserted into the abdomen to visualize the hernia defect on a monitor. The image on the monitor is used to guide the surgeon’s movements. The inguinal hernia sac is removed from the defect in the abdominal wall, and a prosthetic mesh is then placed to cover the hernia defect. While doing this, surgeons are careful to avoid injuring the nerves that are near the hernia that can cause chronic pain if injured, blood vessels that can bleed, or the vas deferens. The small incisions are closed with suturing that dissolve on their own over time. You should discuss all hernia repair options with your surgeon to determine which approach is best for you. The hernia is repaired by a different technique like TAPP, TEP or IPOM. The majority of patients undergoing elective or nonemergent groin hernia repair go home the same day as the surgery once their pain is under control, they have urinated, and they are able to tolerate food or liquids without nausea or vomiting.

Inguinal hernia is one of the most common surgical conditions worldwide, particularly affecting adult males. With advances in minimally invasive surgery, laparoscopic inguinal hernia repair has become a preferred technique due to reduced postoperative pain, faster recovery, and excellent cosmetic outcomes. This article provides a step-by-step demonstration of laparoscopic inguinal hernia surgery, focusing on standard operative principles and surgical anatomy.

Indications for Laparoscopic Inguinal Hernia Repair

Laparoscopic repair is especially indicated in:

• Bilateral inguinal hernias

• Recurrent hernias after open repair

• Patients requiring early return to work

• Obese patients and those seeking minimal scarring

The two commonly practiced techniques are TAPP (Transabdominal Preperitoneal) and TEP (Totally Extraperitoneal) repair.

Preoperative Preparation

• Detailed clinical evaluation and imaging if required

• Informed consent explaining risks and benefits

• General anesthesia is mandatory

• Prophylactic antibiotics administered preoperatively

• Bladder evacuation before surgery

Step-by-Step Surgical Technique (TAPP Approach)

Step 1: Patient Position and Port Placement

The patient is placed in the supine position with slight Trendelenburg tilt. Pneumoperitoneum is created using a Veress needle or open technique. A 10 mm camera port is inserted at the umbilicus, along with two 5 mm working ports in the lower abdomen.

Step 2: Diagnostic Laparoscopy

A thorough inspection of both inguinal regions is performed to identify direct, indirect, or femoral hernias and to rule out occult hernias.

Step 3: Peritoneal Incision

A horizontal peritoneal incision is made approximately 2–3 cm above the hernia defect, extending from the medial umbilical ligament to the anterior superior iliac spine. This exposes the preperitoneal space.

Step 4: Preperitoneal Dissection

Careful dissection is carried out to identify key anatomical landmarks such as:

• Inferior epigastric vessels

• Cooper’s ligament

• Vas deferens and spermatic vessels

• Iliopubic tract

The hernia sac is reduced gently into the abdominal cavity.

Step 5: Mesh Placement

A polypropylene or lightweight composite mesh (usually 10 × 15 cm) is placed to cover the myopectineal orifice, ensuring adequate overlap of all potential hernia sites.

Step 6: Mesh Fixation (Optional)

Mesh may be fixed using tackers, sutures, or fibrin glue, depending on surgeon preference and patient factors. In many cases, non-fixation is sufficient.

Step 7: Peritoneal Closure

The peritoneal flap is closed over the mesh using continuous suturing or tackers to prevent mesh exposure and bowel adhesions.

Postoperative Care

• Early ambulation within 6–8 hours

• Oral intake resumed the same day

• Pain managed with oral analgesics

• Discharge usually within 24 hours

• Return to routine activities in 7–10 days

Advantages of Laparoscopic Inguinal Hernia Surgery

• Less postoperative pain

• Faster recovery and return to work

• Bilateral repair through same ports

• Better visualization of anatomy

• Lower recurrence rates in experienced hands

Possible Complications

• Seroma or hematoma

• Chronic groin pain

• Mesh infection (rare)

• Injury to vessels or nerves

Conclusion

A step-by-step laparoscopic inguinal hernia repair provides a safe, effective, and minimally invasive solution for inguinal hernia management. Proper understanding of anatomy, meticulous dissection, and standardized surgical steps are crucial for achieving optimal outcomes. Laparoscopic hernia surgery continues to be an essential skill for modern surgeons.