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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.

TAPP Inguinal Hernia Repair by Ipsilateral Approach: A Modern Surgical Technique

Inguinal hernias are a common surgical condition that require precise and effective repair to prevent recurrence and complications. Among the minimally invasive techniques available, Transabdominal Preperitoneal (TAPP) inguinal hernia repair is widely used due to its safety, effectiveness, and reduced postoperative pain. Traditionally, TAPP is performed via a bilateral port placement; however, the ipsilateral approach is gaining attention for its potential benefits.

Understanding the Ipsilateral Approach in TAPP

The standard TAPP repair involves placing laparoscopic ports on both sides of the abdomen, regardless of whether the hernia is unilateral or bilateral. However, in the ipsilateral approach, all ports are positioned on the same side as the hernia. This technique can be particularly advantageous for unilateral inguinal hernias and has been proposed to reduce invasiveness further.

Surgical Technique

1. Patient Positioning & Anesthesia

   • The patient is placed in a supine position with a slight Trendelenburg tilt.
   • General anesthesia is administered.

2. Port Placement (Ipsilateral Configuration)

   • A 10mm infraumbilical camera port is placed.
   • Two additional 5mm working ports are inserted on the same side as the hernia (typically at the midline or lateral to the rectus muscle).

3. Peritoneal Incision & Preperitoneal Dissection

   • A peritoneal flap is carefully created over the hernia defect.
   • The preperitoneal space is dissected to expose the hernia sac.

4. Hernia Sac Reduction & Mesh Placement

   • The hernia sac is gently reduced, ensuring no bowel entrapment.
   • A large mesh (usually 10x15 cm) is placed in the preperitoneal space to cover the myopectineal orifice.
   • The mesh is secured without fixation or with minimal tackers to prevent chronic pain.

5. Peritoneal Closure & Final Inspection

   • The peritoneum is closed using sutures or absorbable tacks to prevent mesh exposure.
   • Ports are removed, and incisions are closed.

Advantages of the Ipsilateral Approach

✅ Reduced Contralateral Trauma – Avoids unnecessary instrument manipulation on the healthy side.
✅ Lower Risk of Port-Site Complications – Fewer incisions may lead to reduced infection and pain.
✅ Better Ergonomics for the Surgeon – Allows more intuitive movements for unilateral cases.
✅ Potential for Faster Recovery – Less tissue disruption can contribute to quicker healing.

Clinical Outcomes & Safety

Studies comparing ipsilateral vs. bilateral approaches in TAPP hernia repair have shown:
Comparable recurrence rates when performed correctly.
Similar or reduced postoperative pain levels due to fewer incisions.
Shorter operative time in experienced hands.

Conclusion

The ipsilateral approach for TAPP inguinal hernia repair is an evolving technique that offers potential benefits in select patients with unilateral hernias. While it may not be universally adopted, it provides an ergonomic and less invasive option for surgeons proficient in laparoscopic hernia repair. More research and experience will further refine its role in modern hernia surgery.

Contact us:
World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi, INDIA       
Phone/WhatsApp: +919811416838, +919999677788
 
World Laparoscopy Training Institute
Bld. No: 27, DHCC, Dubai, UAE
Phone: +971525857874
 
World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida, USA
Phone: +1 321 250 765