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Case Reports
. 2024 Jul 15;16(7):e64610.
doi: 10.7759/cureus.64610. eCollection 2024 Jul.

Transabdominal Preperitoneal Repair for a Recurrent Inguinal Hernia After Kugel Hernioplasty Using the Pseudosac of Direct Inguinal Hernia: A Case Report

Takashi Deguchi  1 , Goshi Fujimoto  2 , Junya Shirai  1 , Kentaro Saito  1
Affiliations
Case Reports

Transabdominal Preperitoneal Repair for a Recurrent Inguinal Hernia After Kugel Hernioplasty Using the Pseudosac of Direct Inguinal Hernia: A Case Report

Takashi Deguchi et al. Cureus. .

Abstract

Here, we report a case of laparoscopic trans-inguinal hernia repair (transabdominal preperitoneal repair or TAPP) for a recurrent inguinal hernia following direct Kugel surgery. A 71-year-old man underwent direct Kugel hernioplasty for a right inguinal hernia at another hospital 4 years prior to presentation. The patient subsequently underwent laparoscopic surgery using the TAPP technique, during which the abdominal cavity was visualized with a laparoscope, revealing a tubular mesh protruding towards the abdominal cavity with a direct and indirect hernia ring. Three months post-surgery, no recurrence was observed.

Keywords: case report; kugel; pseudosac; recurrent inguinal hernia; transabdominal preperitoneal (tapp).

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee of Koga Community Hospital issued approval 2024-3. June 3, 2024 Dr. Takashi Deguchi SUNHKOKAI Social Medical Corporation KOGA Community Hospital Division of Gastroenterological Surgery Dear Deguchi Re your application titled: “Transabdominal preperitoneal repair for a recurrent inguinal hernia after kugel hernioplasty using the pseudosac of direct inguinal hernia: A case report”. Thank you for submitting your application for a Literature Review. I can confirm that your application has been given approval from the date of this letter. This approval is valid until June 3, 2027. Details of the approval are as follows: Approval No. 2024-3 Project Title: Transabdominal preperitoneal repair for a recurrent inguinal hernia after kugel hernioplasty Using the pseudosac of direct inguinal hernia: A case report Approval date: June 3,2024 Expiry date: June 3, 2027 The committee would be pleased to receive a copy of the summary of your research study when completed. Good luck with your research. Yours sincerely Dr. Keisuke Koga Director of Research Ethics Chair, Ethics Review Committee (Human Research). Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative plain abdominal computed tomography scan
The small intestine (arrowheads) prolapses into the right inguinal hernia from outside the right inferior epigastric artery IEA, inferior epigastric artery
Figure 2
Figure 2. Laparoscopic findings
The mesh was located medial to the hernia ring, and a direct (arrowhead) and indirect (arrow) hernia were revealed medial and lateral to the inferior epigastric artery, leading to the diagnosis of RL2M3. IEA, inferior epigastric artery
Figure 3
Figure 3. Detached preperitoneal cavity
An incision was made across the Kugel mesh (arrowheads) to separate the peritoneum from the spermatic cord blood vessels and vas deferens along with the mesh, and pseudosac (arrow) was completely released by separating the preperitoneal area. IEA, inferior epigastric artery; CL, Cooper's ligament
Figure 4
Figure 4. Lateral traction - the pseudosac (arrow) utilized for total peritoneal closure
The pseudosac (arrow) was created by detaching the peritoneum of a direct hernia. CL, Cooper's ligament
Figure 5
Figure 5. Total closure of the peritoneum
Total closure of the peritoneum (arrowheads) was achieved by suturing the ventral and dorsal peritoneum to the pseudosac.
See this image and copyright information in PMC

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