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This surgery demonstrates TAPP Inguinal Hernia Repair by Ipsilateral Port by Dr. R.K. Mishra ar World Laparoscop[y hospital. Inguinal hernia repair is one of the most common procedures performed around the world. Laparoscopic hernia repair is an effective procedure when critical principles are done correctly. The surgery’s efficacy is directly and closely related to the surgeon’s anatomical knowledge, skill, and experience. This video is a description of our technique at World Laparoscopy Hospital, including surgical details and technical principles, as well as tips & tricks that we have found essential for an accurate laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. This text also has accompanying photos and videos that the reader can follow visually. We advise always sticking to the principles, steps, and rules.

Inguinal hernia is one of the most common surgical conditions worldwide, and the evolution of minimally invasive techniques has significantly improved patient outcomes. Among these, Transabdominal Preperitoneal (TAPP) repair has gained popularity due to its precision, reduced postoperative pain, and quicker recovery. Recently, the ipsilateral port technique has emerged as an innovative modification that offers better ergonomics and efficiency for laparoscopic surgeons.

What is TAPP Inguinal Hernia Repair?

TAPP, or Transabdominal Preperitoneal repair, is a laparoscopic technique where the surgeon accesses the hernia site through the abdominal cavity. The key steps involve:

Creating a pneumoperitoneum and placing laparoscopic ports.

Dissecting the peritoneum overlying the inguinal region to expose the hernia defect.

Reducing the hernia sac back into the abdominal cavity.

Placing a mesh over the defect in the preperitoneal space.

Closing the peritoneum to cover the mesh and restore normal anatomy.

This method allows excellent visualization of both sides, making it particularly advantageous in bilateral or recurrent hernias.

Ipsilateral Port Technique: The Innovation

Traditional TAPP repair typically uses ports placed at standard midline or contralateral positions. The ipsilateral port approach modifies port placement so that one of the working ports is on the same side as the hernia.

Advantages of Ipsilateral Port Placement:

Ergonomic Instrument Handling: Surgeons experience less fatigue due to more natural hand positioning.

Enhanced Precision: Direct alignment with the hernia sac allows better dissection and mesh placement.

Reduced Operative Time: Simplified movements and access can shorten surgery duration.

Patient Comfort: Smaller and fewer ports can lead to less postoperative pain and faster recovery.

Step-by-Step Overview

Patient Positioning: Supine with slight Trendelenburg tilt for optimal pelvic exposure.

Port Placement:

Umbilical port for the camera

Ipsilateral working port near the hernia site

Contralateral working port for auxiliary instruments

Peritoneal Dissection: Carefully dissect to expose the hernia sac without injuring surrounding structures.

Hernia Reduction and Mesh Placement: Reduce the sac and place a pre-shaped mesh covering the myopectineal orifice.

Peritoneal Closure: Close the peritoneum with a running suture to prevent mesh exposure.

Clinical Outcomes

Studies and surgical experience suggest that TAPP repair using ipsilateral port placement:

Reduces operative time by improving instrument alignment.

Minimizes postoperative pain.

Provides excellent cosmetic results due to smaller and fewer port sites.

Maintains the low recurrence rates associated with conventional TAPP repair.

Conclusion

TAPP Inguinal Hernia Repair by Ipsilateral Port represents a thoughtful evolution of laparoscopic hernia surgery. By combining the advantages of minimally invasive access with ergonomic port placement, this technique enhances surgical efficiency, patient comfort, and overall outcomes. Surgeons experienced in laparoscopy can adopt this modification to optimize their practice and provide superior care for patients with inguinal hernias.