Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing this with traditional mesh stapling. Methods: We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 120 patients in which we fixed the mesh to the anterior abdominal wall using either two prolene threads that passed to the exterior and tied in place or traditional mesh stapling. Results: The operative time is ranged from 35 to 70 minutes for external fixation, 30 to 60 minutes for mesh stapling, and 4 to 51 months for follow-up, and no recurrence occurred in both groups during the procedure. Two cases with post TAPP pain in mesh stapling patients are discussed with reduction of the cost and port size in external fixation patients. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior and it is fixed only to the exterior allowing a reduction in size of the ports and considerable reduction in cost with elimination of TAPP associated post operative pain.
 A. Fingerhut, B. Millat, N. Veyrie, E. Chouillard and C. Dziri, “Inguinal Hernia Repair—Update 2006,” In: E. A. M. Neugebauer, S. Sauerland, A. Fingerhut, B. Millat and G. Buess, EAES Guidelines for Endoscopic Surgery, Springer, Berlin Heidelberg, 2006, pp. 297-309. http://dx.doi.org/10.1007/978-3-540-32784-4_14
 J. Wellwood, M. J. Sculpher and D. Stoker, “Randomised Controlled Trial of Laparoscopic versus Open Hernia Repair for Inguinal Hernia: Outcome and Cost,” British Medical Journal, Vol. 317, 1998, pp. 103-110. http://dx.doi.org/10.1136/bmj.317.7151.103
 D. M. Wright, A. Kennedy and J. N. Baxter, “Early Outcome after Open versus Extraperitoneal Endoscopic Tension-Free Hernioplasty,” Surgery, Vol. 119, No. 5, 1996, pp. 552-527.
 K. W. Millikan, M. L. Kosik and A. Doolas, “A Prospective Comparison of Transabdominal Peritoneal Laparoscopic Hernia Repair versus Traditional Open Hernia Repair in a University Setting,” Surgical Laparoscopy & Endoscopy, Vol. 4, 1994, pp. 247-253.
 P. Kiruparan and S. H. Pettit, “Prospective Audit of 200 Patients Undergoing Laparoscopic Inguinal Hernia Repair with Followup from 1 to 4 Years,” Journal of the Royal College of Surgeons of Edinburgh, Vol. 43, No. 1, 1998, pp. 13-16.
 D. C. Brooks, “A Prospective Comparison of Laparoscopic and Tension-Free Open Herniorraphy,” Archives of Surgery, Vol. 129, No. 4, 1994, pp. 361-366. http://dx.doi.org/10.1001/archsurg.1994. 01420280031004
 A. S. Seid and E. Amos, “Entrapment Neuropathy in Laparoscopic Herniorraphy,” Surgical Endoscopy, Vol. 8, No. 9, 1994, pp. 1050-1053. http://dx.doi.org/10.1007/BF00705717
 C. G. Schmedt, S. Sauerland and R. Bittner, “Comparison of Endoscopic Procedures vs Lichtenstein and Other Open Mesh Techniques for Inguinal Hernia Repair,” Surgical Endoscopy, Vol. 19, No. 2, 2005, pp. 188-199. http://dx.doi.org/10.1007/s00464-004-9126-0
 K. McCormack, B. Wake, J. Perez, C. Fraser, J. Cook and E. Mcintosh, “Laparoscopic Surgery for Inguinal Hernia Repair: Systemic Review of Effectiveness and Economic Evaluation,” Health Technology Assessment, Vol. 9, No. 14, 2005, pp. 1-203.
 P. Ridings and D. S. Evans, “The Transabdominal Pre-Peritoneal (TAPP) Inguinal Hernia Repair: A Trip along the Learning Curve,” Journal of the Royal College of Surgeons of Edinburgh, Vol. 45, No. 1, 2000, pp. 29-32.
 E. A. M. Neugebauer, H. Troidi and C. K. Kum, “The EAES Clinical Practice Guidelines on Laparoscopic Cholecystectomy, Appendectomy and Hernia Repair,” In: E. A. M. Neugebauer, S. Sauerland, A. Fingerhut, B. Millat and G. Buess, Eds., EAES Guidelines for Endoscopic Surgery, Springer, Berlin Heidelberg, 2006, pp. 265-289. http://dx.doi.org/10.1007/978-3-540-32784-4_12
 J. Koniger, J. Redecke and M. Butters, “Chronic Pain after Hernia Repair: A Randomized Trial Comparing Shouldice, Lichtenstein and TAPP,” Langenbeck’s Archives of Surgery, Vol. 389, No. 5, 2004, pp. 361-365. http://dx.doi.org/10.1007/s00423-004-0496-5
 F. Tatulli, G. Chetta, A. Caputi, P. Mastrototaro and T. Ruggieri, “Laparoscopic Inguinal Hernia Repair: Audit of Our Experience with Laparoscopic Trans-Abdominal Pro-Peritoneal Repair (TAPP),” Chirurgia Italiana, Vol. 61, No. 1, 2009, pp. 47-53.
 C. R. Voyles, B. J. Hamilton, W. D. Johnson and N. Kano, “Meta-Analysis of Laparoscopic Inguinal Hernia Trials Favors Open Hernia Repair with Preperitoneal Prosthesis,” American Journal of Surgery, Vol. 184, 2002, pp. 6-10. http://dx.doi.org/10.1016/S0002-9610(02)00878-4
 R. Schwab, O. Schumacher, K. Junge, M. Binnebosel, U. Klinge and H. F. Becker, “Biomechanical Analyses of Mesh Fixation in TAPP and TEP Hernia Repair,” Surgical Endoscopy, Vol. 22, No. 3, 2008, pp. 731-738. http://dx.doi.org/10.1007/s00464-007-9476-5
 M. S. Abdelhamid, “Transabdominal Pre-Peritoneal Inguinal Hernia Repair with External Fixation,” Hernia, Vol. 15, No. 2, 2011, pp. 185-188. http://dx.doi.org/10.1007/s10029-010-0766-9
 S. Olmi, L. Erba, A. Bertolini and A. Scaini, “Fibrin Glue for Mesh Fixation in Laparoscopic Transabdominal Preperitoneal (TAPP) Hernia Repair Indications, Technique and Outcomes,” Surgical Endoscopy, Vol. 20, No. 12, 2006, pp. 1846-1850. http://dx.doi.org/10.1007/s00464-005-0502-1
 S. Kapiris, T. Mavromatis, S. Andrikopoulus, C. Georgiades, D. Floros and G. Diamantoupolus, “Laparoscopic Transabdominal Preperitoneal Hernia Repair (TAPP): Stapling the Mesh Is Not Mandatory,” Journal of Laparoscopic & Advanced Surgical Techniques, Vol. 19, No. 3, 2009, pp. 419-422. http://dx.doi.org/10.1089/lap.2008.0350