Internal hernia after trans-abdominal preperitoneal (TAPP) hernia repair: A case report

Abstract

Introduction: Hernia repair is a common procedure performed by general surgeons. Introduced in 1990s, the use of laparoscopic hernia repair has recently increased and, consequently, rare complications previously unknown have been reported.

Presentation of case: A 43-years-old male patient who underwent a transabdominal preperitoneal patch plasty (TAPP) procedure for symptomatic bilateral inguinal hernia. On the sixth postoperative day, the patient was admitted for small bowel obstruction (SBO) and underwent reoperation; the central portion of the peritoneal suture in the left inguinal region was lacerated and a hole in the peritoneum had performed a hernia orifice, causing small bowel occlusion by preperitoneal herniation. After the hernia was released, the peritoneum was closed again and the surgery was completed.

Discussion: SBO after TAPP procedure is a rare complication and should be considered in patients with abdominal pain and vomiting after TAPP procedure.

Conclusion: This complication can be prevented with appropriate peritoneal closure techniques and treated with early laparoscopic surgery.

Keywords: Complications; Inguinal hernia; Laparoscopy; Small bowel occlusion; Transabdominal preperitoneal hernioplasty.

Fig. 1

CT-Scan performed on the third postoperative day which shows no signs of small bowel obstruction.

Fig. 2

CT-Scan performed on the sixth postoperative day, showed fluid distention of some loops of the small intestine.

Fig. 3

CT-Scan performed on the sixth postoperative day, showed fluid distention of some loops of the small intestine with thickened walls, in the lower left abdominal quadrant without signs of caliber alteration.

Fig. 4

Preperitoneal Hernia through partial dehiscence of the central portion of the surgical suture.

Fig. 5

Peritoneal hernia port through which the prosthesis can be seen on the bottom.