Hernia

Inguinal Hernia Repair (Laparoscopic) (TAPP)

OPERATION: Inguinal Hernia Repair (Laparoscopic) — Trans-Abdominal Pre-Peritoneal (TAPP)
ANAESTHETIC: General anaesthesia
POSITION: Supine, head-down tilt. Surgeon on side opposite the hernia.

INDICATION:
[Symptomatic inguinal hernia — unilateral / bilateral]. [Right / left]. [Primary / recurrent].

PROCEDURE:
WHO Checklist performed. Full abdomen prepared. Bladder catheterised if full.

ACCESS:
Open Hasson technique at umbilicus. 10 mm port inserted into peritoneal cavity under direct vision. Pneumoperitoneum to 13-14 mmHg. 30-degree laparoscope. Two further 5 mm ports placed at umbilical level lateral to the rectus muscles bilaterally under direct vision.

ASSESSMENT:
Bladder identified — median umbilical ligament located. Medial umbilical ligaments, inferior epigastric vessels identified. Internal ring located by divergence of vas deferens (medially) and gonadal vessels (laterally) — triangle of doom identified and noted. Hernia assessed: [direct — medial to epigastric vessels / indirect — lateral]. Contralateral side checked. [Bilateral hernia confirmed.]

PRE-PERITONEAL DISSECTION: