Background The most difficult and tedious step in total extraperitoneal (TEP) laparoscopic hernia repair is the dissection of the sac from the cord structures, especially in large inguinal hernias reaching the bottom of the scrotum. The possibilities of bleeding, vas injury, and missing part of the sac lie mostly in this step. We introduced this modification to the procedure to accomplish this step through a small incision at the neck of the scrotum with sparing the second operator port. Aim The aim of this study is to evaluate this new technique of assisted totally extraperitoneal (ATEP) laparoscopic hernioplasty in the management of patients with large inguinal hernias. Patients and methods This study was conducted on 192 male patients with large inguinal hernias who were randomly arranged into two equal groups: group I included 96 patients who underwent the classical TEP laparoscopic hernioplasty, and group II included 96 patients who underwent the new modification ATEP laparoscopic hernioplasty. The two groups were compared regarding the operative time, intraoperative and postoperative complications, and the hospital stay. Results There were statistically significant reductions in the operative time; the incidence of intraoperative bleeding, vas injury, and incomplete sac excision; and postoperative massive scrotal edema in group II compared with group I, with more or less similar cosmetic results. Conclusion ATEP laparoscopic hernioplasty is a safe and effective procedure to manage patients with large inguinal hernias and achieved better control with lower morbidity than the classic TEP laparoscopic hernioplasty.