To discuss the safety and effectiveness of retrograde puncture following laparoscopic localization to create operative space in totally extra-peritoneal hernia repair (TEP).

A total of 81 adult patients with inguinal hernia who underwent TEP at People's Hospital of Dehong from April 2020 to September 2022 were selected. All patients underwent retrograde puncture following laparoscopic localization to create operative space. The time of creating the preperitoneal space, postoperative complications and recurrence of the patients were observed.

All 81 cases completed TEP surgery, including two cases with low abdominal surgery history. The mean time for creating preperitoneal space was (7.5±2.2) min. There was no case of conversion to laparoscopic trans-abdominal preperitoneal hernia repair. No peritoneum tear and inferior epigastric vessels injury caused by puncture. There were no postoperative bleeding and no hernia recurrence.

Retrograde puncture following laparoscopic localization to create operative space for TEP repair is safe, simple and effective, and can be widely applied.