Modified Lichtenstein Technique for Transinguinal Preperitoneal Prosthesis (Tipp) Repair of Groin Hernia

For the preperitoneal mesh hernioplasty of groin hernias through posterior approaches and other published anterior approaches, the mesh fixation is not done with the inguinal ligament inferiorly, rather, the mesh is overlapped behind the inguinal ligament and on the area which contains the external iliac vessels and important nerves. With the modified Lichtenstein technique, transinguinal preperitoneal placement of the mesh is achieved avoiding dissection or exposure of blood vessels behind the inguinal ligament, the mesh is fixed inferiorly to inguinal ligament as is standard for Lichtenstein technique. Superiorly, medially, and laterally, the mesh is placed preperitoneally behind the buttress of the inguinal muscles.