**5. Material and methods**

We performed laparoscopic inguinal hernia surgery in 163 patients between January 2017 and 2018 in our clinic. Laparoscopic hernia repair was recommended to patients who are suitable for general anesthesia, had no previous abdominal surgery or incarceration or strangulated hernia or without acute mechanical intestinal obstruction. In terms of learning curve, TAPP was performed on first 50 cases and TEP on the following cases. A total of 155 (95%) patients were male and 8 (5%) were female. A total of 51 patients received TAPP (31.2%) and 112 patients (68.7%) received TEP. Eight patients who underwent TAPP (15.6%) were operated for recurrence. Thirteen patients (25.4%) underwent bilateral repair while three (5.8%) patients underwent the same session umbilical hernia repair. The groups were evaluated in terms of operation time, pain scores, recurrence rates, duration of hospitalization and return to daily activity and complication rates. TAPP average operation time is 58 min while in bilateral cases this duration is 72 min. The duration of operation of recurrent cases was 59 min average and there was no significant difference between these patients and the primary cases. A total of 112 patients were treated with TEP technique. Nineteen patients (16.9%) were operated for recurrent hernia, and 14 patients (12.5%) underwent bilateral repair. In three patients (2.6%), the same session umbilical hernia repair was also performed. Average duration of TEP is 47 min while in bilateral cases this duration is observed as elongated, 56 min. The duration of operation in recurrent cases was 56 min and there was no significant difference between these patients and the primary cases. The hospital stay was measured as 1.2 days for TAPP and 1.1 days for TEP, and no significant difference was found between the groups. It was also found that the pain scores between the two groups were similar as 3.2 and 2.9 for TAPP and TEP, respectively. The time to return to the daily activity for TAPP was 5.6 days and for TEP was 5.3 days and no significant difference was found between the two groups. As a complication, seroma in four patients (2.4%), recurrent hernia in two patients (1.2%) and chronic persistent pain in six patients (3.6%) occurred. Patients with recurrence were reoperated. Five patients with chronic persistent pain were treated with medical therapy within 6 months, and one patient with osteitis pubis was detected and curettage was performed by orthopedics clinic. In our study, no significant difference in recurrence, return duration to work, pain score, duration of hospitalization and postoperative complication were detected between the groups.

**7. Laparoscopic transabdominal preperitoneal approach**

that can be used in laparoscopically repaired recurrent hernias.

assistant to sit on the same side of the surgeon (**Figure 1**).

• One 10 mm and two 5 mm in diameter totally 3 trocars

• 15 × 15 cm polypropylene or polyester special shaped patch

sive or non-absorbable suture material) (**Figure 2**).

**8.3. Preparation of the patient and treatment of trocars**

**8. Technical details**

**8.1. Operating room layout**

**8.2. Surgical instruments**

• Veress needle

• 10 mm diameter and 30° angle camera

• 5 mm diameter vessel sealing device

It is stated that TAPP is the first method to be learned because it is applicable in all inguinal region hernia types. As an advantage of the intraabdominal approach, the posterior wall anatomy can be better dominated, so proper and adequate parietalization can be made more comfortable. Compared to TEP, the cost is lower and the learning curve is shorter. TAPP is a highly successful method for both incarcerated and scrotal hernias. Due to intraabdominal vision, providing a wide field of view study is one of its greatest advantages and is a method

Laparoscopic Inguinal Hernia Repair: Technical Details, Pitfalls and Current Results

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The opposite side of the surgical field and both legs are in closed position. In bilateral hernia repair, both arms are in closed position. The videomonitor laparoscopy tower is placed on the patient's foot, on the side to be operated. The operator can be placed on the opposite side of the area to be operated and the camera assistant can be placed on the same side or opposite side of the surgeon depending on the experience and habits of the team. We prefer the camera

• Standard laparoscopic equipment consisting of camera, monitor, light and bag

• Endoinstruments (Atraumatic pens, dissector, scissors, hook, acutenaculum, aspirator)

• Fixing material for mesh detection and peritoneal closure (mechanical stapler, tissue adhe-

A single dose of 1 g second-generation cephalosporin as prophylactic antibiotic is injected half an hour before the onset of operation. The patient should urinate before operation and preoperative fluid resuscitation should be kept to a minimum. Before the operation, the patient
