Inguinal Hernia Repair (Open, Laparoscopic, Robotic)

Procedure Snapshot

• Indication: Symptomatic or incarcerated inguinal hernia.
• Expected duration: ___
• Special instruments: Mesh, laparoscope, balloon dissector, tacker.

Step Workflow — Open (Lichtenstein)

1. Oblique incision above inguinal ligament.
2. Identify cord structures; reduce hernia sac.
3. Reinforce floor with mesh from pubic tubercle → internal ring.
4. Close in layers.

Step Workflow — Laparoscopic (TAPP/TEP)

1. Create preperitoneal space (balloon or trocar).
2. Identify landmarks: pubic tubercle, Cooper’s ligament, inferior epigastrics, vas deferens, testicular vessels.
3. Reduce sac; cover myopectineal orifice with mesh.
4. Fix mesh; close peritoneum (TAPP).

Step Workflow — Robotic

1. Same as TAPP; robotic articulation aids dissection near vas/epigastrics.
2. Sutured fixation common; improved ergonomics.

Key Pimp Questions

• Q: Direct vs indirect?
  A: Direct = medial to inf. epigastrics; Indirect = lateral.
• Q: Triangle of Doom contents?
  A: External iliac vessels (avoid fixation).
• Q: Recurrence after mesh?
  A: < ___ % (PMID 29409842).

Critical Anatomy

• Landmarks: Inguinal ligament, pubic tubercle, inferior epigastric vessels.
• Danger zones: Triangle of Doom (vessels), Triangle of Pain (nerves).

Informed Consent Highlights

• Risks: Recurrence, seroma, neuralgia, testicular atrophy.

Post-op Considerations

• Ambulate same day; avoid heavy lifting 2–4 weeks.

References

• Chassin’s, Hernia section.
• Clinical Scenarios, Groin Hernia chapter.
• Köckerling 2018 (PMID 29409842).