Design: Video

Setting: Urban academic teaching hospital

Patients or Participants: N/A

Interventions: N/A

Measurements and Main Results: Direct inguinal hernias occur medial to the inferior epigastric vessels and protrude through Hesselbach’s triangle. Indirect inguinal hernias originate lateral to the inferior epigastric vessels and protrude through the inguinal canal and into the labia. Femoral hernias occur inferior to the inguinal ligament and protrude through the femoral ring. The path of a retropubic trocar could potentially cross through a direct hernia, but is more medial than an indirect or femoral hernia. The transobturator sling travels behind the pubic rami and exits lateral to the labia, avoiding the potential path of any groin hernia. The single-incision sling does not interact with any type of hernia.

Conclusion: If a hernia is suspected pre-operatively, a full evaluation with an ultrasound or referral to a general surgeon should be considered before sling placement. In the case of a direct inguinal hernia, or if there is a concern that the retropubic space may contain bowel, the transobturator or single incision sling is favored over the retropubic sling. Any approach may be used in the case of an indirect inguinal or femoral hernia or if there was a previous repair.