Another TEP was successfully completed today with clear surgical anatomy and essentially no significant bleeding. The patient had a left inguinal hernia combined with a straight hernia, commonly known as a saddle hernia. This patient would have required two hernia plugs and would have cost about $2,000 for an open hernia ring-filled tension-free repair. Laparoscopic complete extraperitoneal patch placement (TEP) is considered the best procedure for the treatment of inguinal hernias in adults. The advantages of this procedure, which is not transabdominal, are outstanding as it is less painful, faster recovery and reduces the impact of CO2 pneumoperitoneum on the abdominal cavity and the occurrence of intestinal adhesions. However, it has not been widely performed because of its higher technical requirements.