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Case Reports
. 2018 Nov 13;2018(11):rjy296.
doi: 10.1093/jscr/rjy296. eCollection 2018 Nov.

Hybrid method with explorative laparoscopy and anterior open approach for re-recurrent inguinal hernia

Kazuhiko Sakamoto  1 , Akihiro Tokuhisa  1 , Kenyu Nishimura  1 , Ryoji Kamei  1 , Yoshinori Kitamura  1 , Seiichiro Ando  1 , Tatsuhito Yamamoto  1
Affiliations
Case Reports

Hybrid method with explorative laparoscopy and anterior open approach for re-recurrent inguinal hernia

Kazuhiko Sakamoto et al. J Surg Case Rep. .

Abstract

The new guidelines of the HerniaSurge group recommend that only an expert hernia surgeon should repair a re-recurrent inguinal hernia. We report the efficacy of the hybrid method with explorative laparoscopy and anterior open approach for re-recurrent inguinal hernia repair. A 61-year-old man underwent anterior open preperitoneal mesh repair for right inguinal direct hernia and laparoscopic transabdominal preperitoneal repair for recurrence. Two years after the second surgery, re-recurrent inguinal hernia was confirmed. We carried out explorative laparoscopy for the re-recurrent inguinal hernia, which revealed a re-recurrent hernia orifice. We performed the anterior open approach while observing from the abdominal cavity. Explorative laparoscopy can help in accurately determining the orifice of the re-recurrent inguinal hernia. Based on that information, the hernia sac can be reached through the shortest route using the anterior open approach.

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Figures

Figure 1:
Figure 1:
(a) The re-recurrent hernia orifice was confirmed between the mesh (white arrow) at the primary repair and the mesh plug at the secondary repair by transabdominal preperitoneal repair. (b) The mesh plug (black arrow) at the secondary repair got detached from the outside and migrated into the preperitoneal cavity.
Figure 2:
Figure 2:
The hernia sac was easily confirmed because it protruded with abdominal air pressure.
Figure 3:
Figure 3:
By observing from the abdominal cavity, the position of the inlay mesh (arrow head) in the preperitoneal cavity was confirmed to be appropriate.
Figure 4:
Figure 4:
The onlay mesh was fixed on the transverse fascia.
See this image and copyright information in PMC

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References

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