Description

Laparoscopic Transabdominal Preperitoneal (TAPP) inguinal hernia repair has emerged as one of the most refined and minimally invasive techniques for addressing inguinal hernias. Among its leading proponents, Dr. R.K. Mishra has contributed extensively to the advancement and teaching of this procedure, offering a highly systematic and reproducible approach. His surgical walkthrough of left-sided TAPP repair highlights the importance of anatomical precision, gentleness in tissue handling, and mastery of laparoscopic ergonomics. The procedure begins with the establishment of pneumoperitoneum, typically using a Veress needle or an open technique to create a safe working space. Three ports are inserted: a central umbilical port for the laparoscope and two lateral working ports. Dr. Mishra emphasizes that proper port placement is crucial for instrument triangulation, reducing surgeon fatigue, and ensuring smooth dissection of the inguinal region. Upon entering the abdominal cavity, the surgeon identifies the hernia defect on the left side. The peritoneum is incised horizontally above the hernia sac, allowing access to the preperitoneal space. Careful dissection follows, during which important structures—such as the spermatic cord, inferior epigastric vessels, and the triangle of doom—are meticulously preserved. Dr. Mishra stresses the importance of gentle traction and counter-traction to avoid accidental injury, especially in cases with large or long-standing hernias. Once the hernia sac is dissected and reduced, the next step involves preparing the myopectineal orifice for mesh placement. Dr. Mishra’s technique focuses on creating adequate space to accommodate a large, anatomically shaped polypropylene or 3D mesh. This ensures full coverage of the direct, indirect, and femoral spaces, thereby minimizing recurrence. The mesh is anchored either with tackers or by using a non-fixation technique, depending on the patient’s anatomy and surgeon’s preference. The final phase involves closing the peritoneal flap with continuous sutures or tacks, ensuring that the mesh remains completely covered. This step is essential to prevent bowel adhesions and postoperative complications. Dr. Mishra highlights that smooth, wrinkle-free peritoneal closure is a marker of a well-executed TAPP procedure. Laparoscopic left-sided TAPP inguinal hernia repair, as demonstrated by Dr. R.K. Mishra, stands out for its clarity, safety, and efficiency. His detailed surgical walkthrough offers valuable insight into the nuances of minimally invasive hernia surgery, making it an indispensable guide for trainees and practicing surgeons alike. Through his systematic approach and emphasis on anatomical mastery, Dr. Mishra continues to elevate global standards in laparoscopic education and surgical excellence.