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. 2022 Jul 21;14(7):e27117.
doi: 10.7759/cureus.27117. eCollection 2022 Jul.

Indications and Outcomes of a Hybrid Method Combining Laparoscopic and Anterior Approaches for Inguinal Hernia Repair

Nao Kakizawa  1 , Shingo Tsujinaka  2 , Yuki Mizusawa  1 , Sawako Tamaki  1 , Ryo Maemoto  1 , Erika Machida  1 , Yuta Muto  1 , Masaaki Saito  1 , Nobuyuki Toyama  1 , Toshiki Rikiyama  1
Affiliations

Indications and Outcomes of a Hybrid Method Combining Laparoscopic and Anterior Approaches for Inguinal Hernia Repair

Nao Kakizawa et al. Cureus. .

Abstract

Introduction Surgery for complex inguinal hernia (IH) (recurrent IH or IH after radical prostatectomy (RP)) may be difficult because of the presumed scar or adhesion in the retropubic space. A hybrid method combining the laparoscopic and anterior approaches (HLAA) in a bidirectional surgical technique may be an option in complex IH cases. Methods Patients at our institution who underwent IH repair for complex IH using HLAA from April 2018 to November 2019 were included. We retrospectively evaluated the patient characteristics, IH diagnosis, intraoperative variables, complications, and hernia recurrence during the follow-up period. Results Twenty patients were involved in this study. Seven patients underwent hLAA for recurrent IH, whereas the remaining 13 underwent hLAA for IH after RP. Five patients had bilateral IH, all of whom had IH after RP. The type of IH was lateral in 21 patients, medial in six patients, and lateral and medial in two patients. Hernia repair was performed using a patch alone in two patients and a plug and patch in 18 patients. Seroma or hematoma was observed in five patients, and one patient experienced chronic pain. No hernia recurrence was observed during the median follow-up period of 24 months. Conclusion hLAA could facilitate precise diagnosis and intraoperative confirmation of repair for recurrent IH and IH after RP. The intraoperative findings and the cause of recurrence can be easily shared among surgeons in hLAA. Further investigations are necessary to determine the long-term efficacy of hLAA in a larger cohort.

Keywords: complex inguinal hernia; hybrid method; inguinal hernia after prostatectomy; inguinal hernia repair; recurrent inguinal hernia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A case of recurrent IH on the right side after TAPP, medial hernia.
The mesh (shown by arrows) that was inserted during previous surgery and shrinking showed through the peritoneum, and the hernia orifice (arrowheads) was 3cm in diameter. TAPP- transabdominal preperitoneal approach
Figure 2
Figure 2. A case of recurrent IH on the right side after TAPP, medial hernia.
The hernia sac (arrow) was inflated. TAPP- transabdominal preperitoneal approach
Figure 3
Figure 3. A case of recurrent IH on the right side after TAPP, medial hernia.
A repair mesh (arrowheads) was plugged into the hernia orifice. TAPP- transabdominal preperitoneal approach
Figure 4
Figure 4. A case of left-sided recurrent IH after bilayer repair, medial hernia.
The hernia orifice (arrowheads) was 1.5 cm in diameter and severe adhesion (arrows) was suggested.
Figure 5
Figure 5. A case of right-sided IH after robot-assisted RP, lateral hernia.
The hernia orifice (arrowheads) was 1 cm in diameter.
Figure 6
Figure 6. A case of right-sided IH after robot-assisted RP, lateral hernia.
The hernia orifice (arrowheads) was 2 cm in diameter.
See this image and copyright information in PMC

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