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Laparoscopic Inguinal Hernia Repair (TEPP) Video by SAGES




 Surgeon: Daniel Marcus, MD

Following are the gross steps

Setup


  • No Foley
  • Low pressure pneumoperitoneum (12mm Hg)


Position and Instruments


  • Arms tucked
  • Surgeon stands on contralateral side of hernia
  • 5 mm short jaw graspers
  • 2 - 5mm short trocars
  • Balloon for initial dissection of preperitoneal layer


Creating operating space


  • Infraumblical dissection to anterior fascia
  • Exposure of rectus muscle
  • Reflect muscle to expose posterior  sheath
  • Insert dissecting balloon with 30 degree 10mm scope
  • Baloon dissection for initial exposure


Sac Dissection


  • Completely reduce the hernia sac
  • Transect and ligate if too difficult
  • Reduce direct pseudosac
  • Identify and protect cord structures


Mesh Placement


  • Mark mesh to ensure orientation
  • Secure with tacks, glue or without fixation
  • Place down to the level of psoas

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