Surgical video: the success of TAPP (transabdominal preperitoneal) or TEP (totally extraperitoneal) approach for inguinal hernias is evident. Laparoscopic hernioplasty have resulted in early recovery to normal activities and a lower incidence of wound infection. However, the best approach in repairing large inguinoscrotal hernias and the optimal management of the distal sac and its risks are still debated. Visceral or cord structures damage, seroma, hematoma, as well as ischemic orchitis are not negligible when opting for a complete dissection of the hernia sac which may extend deep into the scrotum. This technique permits the management of large distal sacs avoiding clinical important injury to cord structures when repairing large inguinoscrotal hernias.
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