How are the ports removed and defects closed in totally extraperitoneal (TEP) laparoscopic inguinal hernia repair?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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At the completion of the operation but before desufflation, an additional step that may be considered is to spray the preperitoneal space with 20 mL of 0.5% bupivacaine with epinephrine for long-acting local analgesia and improved hemostasis (see the video below). [96]

Laparoscopic inguinal hernia repair: TEP. Local anesthesia infiltration.

While the preperitoneal space is being desufflated under direct vision, a blunt grasper should be placed against the lower corner of the mesh just lateral to the cord structures (see the image below). This prevents the mesh from rolling upward and exposing the lateral aspect of the internal ring to recurrence.

Laparoscopic inguinal hernia repair: TEP. Desufflation.

Finally, larger trocar site fascial defects are closed with a figure-eight 0 absorbable suture, the skin is approximated, and the Foley catheter (if used) is removed.

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