Figure 0001: Transverse infraumbilical incision, with incision in anterior rectus sheath

Mentions: A 10-mm infraumbilical transverse incision is made. The anterior rectus sheath is exposed and transverse incision is then made on the anterior rectus sheath to one side of the midline to avoid inadvertent opening of the peritoneum [Figure 1]. The margins of incised sheath are held in stay sutures using vicryl 1–0 [Figure 2]. The rectus muscle is retracted laterally from the midline and by finger dissection a space is created between the rectus muscle and the posterior rectus sheath.

Chowbey PK, Khullar R, Sharma A, Soni V, Baijal M - J Minim Access Surg (2006)

Bottom Line: Once well versed with the approach we have found it an efficient and cost effective method for groin hernia repair.Endoscopic totally extraperitoneal hernia repair is a technically demanding procedure.To make the procedure cost effective and prevent hernia recurrences, we have modified and innovated to simplify the procedure.This modification which we have named the SGRH technique, innovates by creating the preperitoneal working space with the help of an indigenous glove finger balloon.With the modified SGRH technique we have found TEP to be safe, cost effective, reproducible and without significant complications.

Affiliation: Minimal Access and Bariatric Surgery Centre, Sir Ganga Ram Hospital, New Delhi - 110 060, India.

Abstract: Laparoscopic approach for hernia has evolved rapidly over the past decade. We adopted the TEP repair early as we believe in preserving the sanctity of the coelomic cavity. Once well versed with the approach we have found it an efficient and cost effective method for groin hernia repair.Endoscopic totally extraperitoneal hernia repair is a technically demanding procedure. Indepth anatomical knowledge, training and advanced technical skill is needed for the surgeon to perform this procedure. To make the procedure cost effective and prevent hernia recurrences, we have modified and innovated to simplify the procedure.This modification which we have named the SGRH technique, innovates by creating the preperitoneal working space with the help of an indigenous glove finger balloon. A rolled mesh makes placement and fixation easier in the limited working space. The mesh is unrolled on the peritoneal surface (floor), a manouver which is technically simpler. On desufflation the mesh comes to appose the Fruchad's orifice covering all potential hernial sites. With the modified SGRH technique we have found TEP to be safe, cost effective, reproducible and without significant complications.