Technique of suturing the mesh in laparoscopic total extra peritoneal (TEP) repair of inguinal hernia

Abstract

For laparoscopic repair of inguinal hernia, total extraperitoneal approach is the procedure of choice. The insertion of a mesh in laparoscopic total extraperitoneal repair (TEP) of an inguinal hernia with proper orientation and spreading it without wrinkles and folds in the preperitoneal space, however, is difficult to learn and carry out. Prolene mesh is also known to shrink and sometimes get displaced in the preperitoneal space giving rise to recurrences. We describe here an easy innovative technique of insertion of mesh and suture fixation. The surgeon has full control over the mesh and placement is accurate. One hundred hernias in 78 male patients were repaired. The same technique was used in all the patients and by one surgeon. In the technique, three midline ports were used. A dissection balloon and Tackers were not used. The mesh was fixed by sutures at the anatomical line joining the two anterior superior iliac spines with the help of suture hooks. There were no recurrences in 24 months of follow-up. There were no intraoperative complications. Mean operative time was 35 minutes. There was no conversion to an open or intraperitoneal approach. There was no incidence of mesh or wound infection. Many surgeons believe that the recurrence rate will increase when the mesh is not fixed. My technique of fixing the mesh is easily reproducible and economical. TEP with suturing the mesh is now my standard approach for inguinal hernia repair.