Transabdominal preperitoneal repair for a recurrent inguinal hernia after Kugel procedure using the medial umbilical ligament: A case report

Abstract

The Kugel procedure resulted in extensive adhesion in the preperitoneal space. Performing a transabdominal preperitoneal repair (TAPP) for recurrent hernia after Kugel procedure is extremely difficult. In this case report, we present the case of a 81-year-old male who presented with recurrent inguinal hernia after Kugel procedure 8 years ago. Transabdominal laparoscopy was performed first. Indirect hernia formed inferior to the lateral edge of the previous mesh was diagnosed under laparoscopy. The patient's medial umbilical ligament (MUL) was big enough and could be completely released by separating the Retzius space. Finally, TAPP was successfully performed by using the MUL to create and close the preperitoneal space. No perioperative complications or hernia recurrence was observed 1 year after the surgery. Using the MUL to deal with preperitoneal problems was practical and feasible.

Keywords: Kugel procedure; medial umbilical ligament; recurrent inguinal hernia; transabdominal preperitoneal repair.

Figure 1

Creating the preperitoneal space and placing the patch. (a) A recurrent right indirect inguinal hernia was confirmed with the hernia sac protruding through the internal ring at the outer side of a Kugel patch. (b) Creation of the preperitoneal space. (c) The dashed area indicates the separation area of superior peritoneum. (d) A right Bard 3Dmax patch was cut open on 12 o’clock to be inserted in the preperitoneal space, covering the Kugel patch

Figure 2

The medial umbilical fold was pulled laterally and sutured to the peritoneum by a Y-shaped continuous suture. The preperitoneal space was completely closed to avoid contact between the patch and the intra-abdominal organs