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 the 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.

Inguinal hernia repair has evolved significantly over the past few decades, with laparoscopic techniques offering minimally invasive alternatives to traditional open surgery. Among these techniques, TAPP (Transabdominal Preperitoneal) Hernia Repair has gained popularity due to its precision, reduced postoperative pain, and quicker recovery. An emerging variation, TAPP Hernia Repair using Ipsilateral Port, further optimizes surgical ergonomics and efficiency.

What is TAPP Hernia Repair?
TAPP Hernia Repair involves entering the peritoneal cavity laparoscopically, creating a preperitoneal space, and placing a mesh to reinforce the abdominal wall. Unlike open repair, TAPP allows the surgeon to visualize both groins, making it suitable for bilateral or recurrent hernias.

Ipsilateral Port Technique
The Ipsilateral Port Technique involves positioning the laparoscopic working port on the same side as the hernia. This contrasts with the traditional contralateral or midline port placement. The approach offers several advantages:

1. Ergonomic Access: Working directly over the hernia site reduces instrument angulation, improving precision during dissection and mesh placement.

2. Reduced Operating Time: Direct access allows smoother and faster handling of the hernia sac and surrounding structures.

3. Better Visualization: Ipsilateral port placement provides an optimal view of the defect and critical structures such as the vas deferens and spermatic vessels.

4. Versatility: Particularly useful in patients with unilateral hernias or prior contralateral surgery, minimizing interference with adhesions or scar tissue.

Step-by-Step Procedure

1. Patient Positioning: The patient is placed supine with slight Trendelenburg tilt to allow bowel displacement.

2. Port Placement:

   • A primary camera port is placed at the umbilicus.

   • Ipsilateral working ports are inserted on the same side as the hernia, usually in a triangular configuration to allow triangulation.

3. Peritoneal Incision: The peritoneum over the hernia defect is incised to access the preperitoneal space.

4. Hernia Sac Dissection: Careful dissection is performed to separate the sac from surrounding structures.

5. Mesh Placement: A pre-shaped synthetic mesh is introduced and spread over the myopectineal orifice, ensuring coverage of all potential defects.

6. Peritoneal Closure: The peritoneum is closed using sutures or tacks, preventing mesh exposure to intra-abdominal contents.

7. Port Closure: After inspection, ports are removed, and incisions closed.

Advantages of Ipsilateral Port TAPP Repair

• Minimally invasive with smaller incisions.

• Reduced postoperative pain and faster recovery.

• Lower recurrence rates due to precise mesh placement.

• Improved ergonomics for the surgeon, especially in complex or recurrent hernias.

Considerations and Limitations

• Requires advanced laparoscopic skills.

• Not ideal for large, complicated, or incarcerated hernias.

• Proper patient selection is critical to avoid complications such as injury to the bladder, bowel, or vascular structures.

Conclusion
TAPP Hernia Repair by Ipsilateral Port represents a modern, ergonomic approach to minimally invasive hernia surgery. With careful patient selection and skilled execution, it offers the benefits of reduced pain, faster recovery, and excellent surgical outcomes. As laparoscopic techniques continue to evolve, ipsilateral port placement may become a preferred approach for select cases, enhancing both surgeon efficiency and patient satisfaction.

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