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Page 2 of 6 Ielpo. Mini-invasive Surg 2021;5:10 I http://dx.doi.org/10.20517/2574-1225.2021.01

Figure 1. Trocars placement.

Figure 2. Surgical field.

Surgical technique at our center
A single dose of first-generation cephalosporin is given at the induction of anesthesia. The operation is
performed under general anesthesia with the pneumoperitoneum established through a Veress needle in
[3]
the left subcostal space, as has been previously described . Three trocars are placed, as shown in Figure 1. The
peritoneum is opened approximately at the level of the lateral trocar and extended medially in the direction
of the superior margin of the internal inguinal ring, up to the residue of the umbilical artery. When the
Cooper ligament is exposed, the hernia sac is isolated and reduced, freeing the spermatic cord [Figure 2].
The entire video can be viewed at: https://youtu.be/6EIILTdWhoI.

Postoperative pain: the main issue of laparoscopic inguinal hernia repair
Persistent postoperative pain after placement of staples to secure the mesh, along with the discovery of the
“triangle of doom” and “triangle of pain”, have led to the recommendation of using only a few staples or
[2]
replacing them with glue . This eliminates the risk of lateral cutaneous femoral nerve entrapment, which
is the main cause of chronic pain. The same suggestions are extended to the closure of the peritoneum,
replacing staples as much as possible with suture or glue . These modifications might increase the
[2]
immediate costs. However, apart from the clinical advantages, these may entail some cost savings in the
long term that only a real cost-effectiveness analysis can detect.

The type of mesh used, its fixation, and the peritoneal closure for the TAPP technique are still some of the
most important topics under discussion, as several modifications of the procedure have been proposed
since its first description .
[2-5]