utilisation of umbilical hernia defect for insertion of laparoscope and balloon dissector in totally extra peritoneal hernia repair

introduction with the growing popularity of totally extraperitoneal (tep) laparoscopic inguinal hernia repair, many surgeons will inevitably face the clinical conundrum of how to simultaneously repair an umbilical hernia and an inguinal hernia via tep approach. case presentation in this case report, we describe the successful use of the umbilical hernia defect to insert the balloon dissector and gas insufflator in the pre-peritoneal plane without making an additional fascial incision. conclusions we suggest that this best preserves the integrity of the umbilical hernia repair by avoiding an additional area of weakness in the rectus sheath.