Which anatomic structures should be identified during dissection in transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

The procedure should always begin with careful inspection of the anatomy of the pelvis and bilateral groins (see the video below).

Laparoscopic inguinal hernia repair: TAPP. Inspection of inguinal anatomy and identification of key structures.

The following key structures should be identified:

  • Median and medial umbilical folds
  • Lateral umbilical folds and epigastric vessels (see the first image below)
  • Vas deferens and spermatic vessels (see the second image below)
  • Iliac vessels
  • Hernia defect (direct or indirect) (see the third image below)
Laparoscopic inguinal hernia repair: TAPP. Inferio Laparoscopic inguinal hernia repair: TAPP. Inferior epigastric vessels running up abdominal wall. These vessels help distinguish indirect from direct inguinal hernia.
Laparoscopic inguinal hernia repair: TAPP. Normal Laparoscopic inguinal hernia repair: TAPP. Normal anatomy of left inguinal region in male, with testicular vessels and vas deferens entering medially.
Laparoscopic inguinal hernia repair: TAPP. Right i Laparoscopic inguinal hernia repair: TAPP. Right indirect inguinal hernia.

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