LAUSR

To present the rationale and surgical technique of the internal inguinal orifice suturing during transabdominal preperitoneal hernia repair of large inguinal hernias. The surgical steps of a laparoscopic transabdominal preperitoneal hernia repair (TAPP) with the addition of the suturing reconstruction of the internal orifice are presented. A 52-year-old man presented with a large symptomatic right inguinal hernia. A TAPP repair was performed. Due to a significantly widened internal inguinal orifice, reconstruction of the deep ring was performed by suturing the transversalis fascia arc to the iliopubic tract with a self-locking 2-0 stitch in a continuous fashion. Accordingly, a medium-weighted polyester mesh was applied. The patient had an uneventful postoperative period, without symptoms of chronic pain or discomfort at a 6-month follow-up. During the laparoscopic repair of large indirect inguinal hernias, suturing reconstruction of the internal orifice, similar to the common practice for open inguinal hernia repair, may reduce mesh eventration and recurrence.