**1. Background**

Over the past 30 years, hernia surgery has become increasingly complex due to introduction of novel endoscopic, but also conventional techniques. The "Tailored Approach" is now used to describe the differentiated use of different techniques to decrease the risks in management of hernia [1]. The first revolution of open tension-free Lichtenstein Repair in 1989 significantly reduced the recurrence rate while the second revolution was the application of Laparoscopic

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

inguinal hernia repair in 1992. Laparoscopic inguinal hernia repair can be done either by trans abdominal pre-peritoneal (TAPP) or totally extra-peritoneal (TEP) approach. Laparoscopic inguinal hernia shows advantage over tension-free Liechtenstein repair in terms of less pain, early return to work, smaller scars and low recurrence rates. TEP repair of inguinal hernia has gained popularity in last two decades since 1st introduced by Dulucq in 1992 [2]. TEP repair of inguinal hernia is now a standard surgical technique [3]. It also avoids the chances of missing femoral, obturator and contralateral inguinal hernia and simultaneously give the operating surgeon an opportunity to repair at the same time [2, 4]. Fixing a mesh over the myopectineal orifice at the time of TEP or TAPP repair prophylactically prevents femoral or obturator hernia formation.

a technique to access pre-peritoneal space by 5 mm Visiport using indigenously made simple retractor device. This retractor device was given the name "Manish Retractor" made by 2 ml sterile plastic syringe. This approach gives the advantage to insert the first trocar under complete vision which prevents any accidental injury to peritoneum at this stage. We have also innovated a simple technique to insert an adequate size light weight polypropylene mesh

"555 Manish Technique" for Mini TEP Repair http://dx.doi.org/10.5772/intechopen.76356 27

**4. Surgical steps of Mini TEP repair by "555 Manish Technique"**

Three 5 mm Visiport (Endopath XCEL bladders trocar: Ethicon) (**Figure 1**).

15 × 10 cm size, light weight polypropylene mesh (Ultrapro Mesh; Ethicon).

Two milliliters plastic syringe to make "Manish Retractor".

Laparoscopic instruments (Maryland dissector, Grasper, scissors).

through 5 mm port using "Tail pull" technique.

**4.1. Instruments used in "555" technique**

Five millimeters 0 or 30-degree telescope.

**Figure 1.** Instruments used in "555 Manish Technique".

Silk thread No 1-0 on needle.

Tacker for mesh fixation.
