Laparoscopic Intraperitoneal Onlay Mesh Inguinal Hernia Repair

The intraperitoneal onlay mesh technique has become the second most common laparoscopic inguinal herniorrhaphy. A prosthesis is placed on the intra-abdominal side of the peritoneum and stapled in place using the same landmarks as for the transabdominal preperitoneal approach: symphysis pubis medially, abdominal wall superiorly, iliopubic tract inferolaterally, and Cooper's ligament inferomedially. This avoids an extensive dissection of the preperitoneal space. The major appeal of this procedure is its speed and simplicity. However, it must be considered as an experimental procedure because of the possibility of complications caused by adhesions to the intra-abdominally placed prosthesis.