Respect the Layer: Preserving the Transversalis Fascia in TAPP Hernia Repair

During laparoscopic TAPP repair, one of the most delicate and essential steps is the separation of preperitoneal fat from the transversalis fascia. This fascial layer forms the true posterior wall of the inguinal canal and serves as the foundation on which the mesh will lie. Preserving it intact maintains structural strength, reduces recurrence risk, and ensures proper mesh integration. Dissection should follow the natural avascular plane, using traction–counter-traction and blunt sweeping movements rather than cutting. When we remove the fat cleanly off the fascia, the defect can be clearly assessed, anatomical landmarks become sharper, and cord elements remain safe. Intentional incision or tearing of the transversalis fascia should be avoided, as it weakens the repair platform and complicates technique. Mastery of this plane is a key skill that transforms a hernia repair from adequate to durable.