TEP repair of inguinal hernia has gained popularity in last two decades. TEP repair has steep learning curve due to limited working space. The current Hasson trocar approach is the only technique known among laparoscopic surgeons. Creating pre-peritoneal space without injuring the peritoneum is again a challenging task in the initial part of surgery. Accidental pneumoperitoneum can further compromise the pre-peritoneal space which leads to difficult dissection and prolongation of operative time. Larger infra-umbilical incision for large cone of Hasson trocar has its own complications in terms of more pain, more SSI, incisional hernia, increased cost for morbidity management and suboptimal cosmetic result due to large scar below the belly button. We have innovated a “555 Manish Technique” which addresses the shortcomings of conventional TEP repair. We complete Mini TEP repair by all three 5 mm ports using “555 Manish Technique” with the help of an indigenous “Manish Retractor” which plays a key role. We have also innovated a simple technique to insert an adequate size light weight polypropylene mesh through 5 mm port using “Tail pull” technique. “555 Manish Technique” is simple, less invasive, less morbid, time saving, cost effective and having better cosmetic results and increased patient satisfaction.
Part of the book: Hernia Surgery and Recent Developments