Minimising dissection and securing mesh in giant inguinoscrotal hernia repair: A modified laparoscopic transabdominal pre-peritoneal technique

ABSTRACT: Giant inguinoscrotal hernias (EHS L3) present technical challenges during laparoscopic repair, including difficulty in complete sac dissection, increased risk of seroma formation, injury to cord structures and potential mesh migration in markedly dilated deep inguinal rings (EHS L3). We present a retrospective cohort of seven patients with primary indirect giant inguinoscrotal hernias operated between January and July 2024 using a modified transabdominal pre-peritoneal (TAPP) technique involving dissection of the hernia sac only up to the deep inguinal ring with abandonment of the distal sac, combined with intracorporeal deep ring closure before mesh placement. This aims to minimise dissection-related morbidity and secure mesh position, in line with the Pascal's law principles. In seven patients with primary indirect giant inguinoscrotal hernias (mean deep ring diameter 4.0 cm and range 3.5-5 cm), all underwent TAPP repair with this modification. The mean follow-up was 15 months, during which no recurrences, clinically significant seromas or cord-related complications were observed. This simple, reproducible technique may enhance the outcomes in large L3 hernias by reducing dead space and optimising mesh stability.