The document provides details on the anatomy and technique for performing a laparoscopic totally extra-peritoneal (TEP) approach for groin hernia repair. Key steps include: 1) gaining access to the pre-peritoneal space through an infraumbilical incision; 2) inserting additional ports under direct vision; 3) completing dissection of the pre-peritoneal space to expose the hernia; and 4) placing a large piece of mesh without fixation to cover the hernia defect. Important anatomical structures are identified during dissection, including the inferior epigastric vessels and vas deferens, to properly expose direct and indirect hernias.

1. Anatomy & Technique of the Laparoscopic Totally Extra-Peritoneal Approach for Groin Hernia Repair Abeezar I. Sarela Consultant Surgeon St James’s University Hospital, Leeds