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TAPP inguinal hernia repair

• wide peritoneal incision
• medial exposition (coopers ligament)
• lateral exposition (triangle of pain)
• free annulus ring
• cross checking anatomy (left side duct first
  right side vessels first)
• reposition of sack/fascia transversalis
• free medial rim between duct and bladder
• extensive peritonealization (duct and vessels)
• mesh 15 x 10 cm, overlap gt 3 cm, no slit, max 6
  clips
• running suture for closure of peritoneal incision

single institution experience 13,000
consecutive pttrecurrence rate 0.7
1993 2006, Reinhard Bittner, Stuttgart