The pneumoperitoneum is obtained by primary insufflation with the Visiport (LUQ insertion for midline or right side hernia); two other 5mm ports placed conveniently are added. The hernia contents are reduced. A peritoneal incision is made to allow a 5cm clearance from the hernia neck; the sac is dissected with care to avoid laceration of the peritoneum. A slightly oversized Prolene mesh is used in this situation. The mesh is stapled in two rows around the defect; any poorly positioned tacks are removed and the excess mesh is trimmed. The peritoneum is closed to avoid contact between bowel and mesh.