Inguinal hernia--the practicalities of TAPP repair

In a previous paper in this Journal, the case for laparoscopic inguinal hernia repair by the transabdominal preperitoneal (TAPP) approach was made, in terms of superiority of outcomes in both recurrence rate and long-term symptoms. This approach has been used by many people, but not always with such good outcomes. This may be due to inattention to detail. The technique used by the author is described, as if following the patient through his surgical pathway. Instrumentation, materials (including composition, configuration and placement) are delineated, suggesting that tailoring the mesh to the individual patient and his hernia are justified, after looking at the outcomes for different mesh sizes.