General Surgery

Inguinal Hernia Repair (Laparoscopic) (TEP)

OPERATION: Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair (TEP) — Right / Left / Bilateral
ANAESTHETIC: General anaesthesia
POSITION: Supine, slight Trendelenburg

INDICATION:
[Unilateral / bilateral / recurrent] inguinal hernia. Laparoscopic approach chosen for [bilateral disease / recurrence / patient preference].

PROCEDURE:
WHO Checklist performed. Infraumbilical skin crease incision. Anterior rectus sheath opened on [ipsilateral] side. Rectus muscle retracted laterally. Balloon trocar inserted and advanced into the pre-peritoneal space behind the posterior rectus sheath, directed towards the pubic symphysis. Balloon inflated under direct vision to develop the pre-peritoneal workspace. Two further 5mm midline working ports inserted.

Inferior epigastric vessels identified as anatomical landmark. Dissection carried laterally and inferiorly. Cooper's ligament cleared. Pubic symphysis identified medially.

Hernia sac identified: [direct / indirect]. Direct defect: peritoneal sac inverted. Indirect sac: dissected off cord structures and reduced; sac ligated at neck if large. Vas deferens and testicular vessels identified and protected throughout.

Pre-peritoneal space developed laterally to accommodate mesh. [Contralateral side explored and [found to be normal / hernia identified and repaired in identical fashion)].

Flat polypropylene mesh [15×15 cm / 15×10 cm] positioned to cover direct, indirect, and femoral spaces. Secured with tacks to Cooper's ligament and around the defect [taking care to stay above the iliopubic tract laterally to avoid nerve injury].

Pneumodissection released, mesh positioned by peritoneal compression against abdominal wall as pressure reduced. Port sites closed.

FINDINGS:
[Direct / indirect / both] hernia, [right / left / bilateral]. No peritoneal breach. Mesh lying flat.

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Light activities for 1 week. Avoid heavy lifting 4–6 weeks. Same-day discharge if appropriate.