Group A (TAPP)

After GA the pneumo-peritoneum was created through supra umbilical port. After achieving intra-abdominal pressure 14 mm of hg, working port are placed. One 10 mm camera port at supra umbilical region rest two 5 mm port at mid clavicular line at level of umbilicus. After inspection of abdomen, peritoneal incision 5 cm cranial to inguinal defect is given. Pre-peritoneum space is created. cooper ligament is identified medially. The medial limit of dissection is opposite side of cooper ligament. Cord structures are identified and hernia sac is separated from cord structures. The lateral limit of dissection is counter part of anterior superior iliac spine(ASIS). The lower limit of dissection is vas deferens turn to medially or mid of psoas muscle. After proper dissection a 15x12 cm poly propylene mesh is placed in pre-peritoneum space. The peritoneum sutured with absorbable suture. Port site is closed with proper suture.

Group B (TEP)

After GA, A 10mm port just below the umbilicus was made for the 10-mm 30^o telescope. The rectus muscle was retracted laterally after incising the anterior rectus sheath and a blunt dissection was done using a peanut for the 10–12-mm port and the 10-mm 30^o telescope to create preperitoneal space. Further dissection proceeded with the telescope until the pubic symphysis was seen in the midline. Two 5-mm ports were inserted, one just above the pubic symphysis and the other in the midline between umbilical port and pubic symphysis. The pubic symphysis is the first anatomical landmark recognized. The dissection proceeded laterally, identifying the inferior epigastric vessels, and further laterally up to correspond to the anterior superior iliac spine. The peritoneal flap was then raised inferiorly exposing the deep ring, triangle of doom, psoas major muscle, and the nerves. The peritoneum was teased down as low as possible. The femoral/direct hernia was easily reduced before identifying the inferior epigastric vessels. The indirect hernia sac was reduced completely if the sac was incomplete; the hernia sac was divided after ligation if it was a complete hernia. A 15x 12 cm polypropylene mesh is used. The mesh was unrolled and left in the preperitoneal space, adequately covering the deep inguinal ring, Hasselbach’s triangle, and femoral hernia sites. The pneumoperitoneum was released. The fascia of the umbilical port was closed using Vicryl suture. The port sites were closed. Skin is sutured with staplers.

We will measure any intraoperative complication like bowel or vascular injury in both group and record accordingly.

Conversion will be noted in both group if it is required. The reason of conversion will also be noted