Methodical placement of mesh during endoscopic extraperitoneal inguinal hernioplasty

Abstract

Endoscopic extraperitoneal inguinal hernioplasty has been gaining in popularity worldwide recently. Placement of mesh remains a technically challenging part of the procedure. This paper describes a systematic method for the placement of mesh during endoscopic inguinal hernioplasty. To broaden the endoscopic view and maximize working space, the mesh should be kept far from the telescope within the limited extraperitoneal space. Unfolding the mesh requires prior stabilization of the mesh at one point, to avoid uncontrolled migration of the whole mesh and subsequent loss of mesh orientation. Mastering the skill of two-handed technique is essential for coordinated manipulation and expeditious mesh placement. Before concluding the procedure, a trial of deflation can help to ensure appropriate repositioning of the peritoneum without displacement of the mesh.