Single-Incision Laparoscopic Intraperitoneal Onlay Mesh Repair for the Treatment of Multiple Recurrent Inguinal Hernias

Abstract

Introduction:Despite an exponential rise in laparoscopic surgery for inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, an increasing number of patients present with recurrent hernias after having failed anterior and laparoscopic repairs. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair for these hernias.Materials and methods:All patients referred with multiply recurrent inguinal hernias underwent SIL-IPOM from November 1 2009 to October 30 2013. A 2.5-cm infraumbilical incision was made and a SIL surgical port was placed intraperitoneally. Modified dissection techniques, namely, “chopsticks” and “inline” dissection, 5.5 mm/52 cm/30° angled laparoscope and conventional straight dissecting instruments were used. The peritoneum was incised above the symphysis pubis and dissection continued laterally and proximally raising an inferior flap, below a previous extraperitoneal mesh, while reducing any direct/indirect/femoral/cord lipoma before placement of antiadhesive mesh that was fixed into the pubic ramus as well as superiorly with nonabsorbable tacks before fixing its inferior border with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh.Results:There were 9 male patients who underwent SIL-IPOM. Mean age was 55 years old and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes with hospital stay of 1 day and umbilical scar length of 21 mm at 4 weeks' follow-up. There were no intraoperative/postoperative complications, port-site hernias, chronic groin pain, or recurrence with mean follow-up of 20 months.Conclusions:Multiply recurrent inguinal hernias after failed conventional anterior and laparoscopic repairs can be treated safely and efficiently with SIL-IPOM.

Multiple concurrent bilateral groin hernias in a single patient; a case report and a review of uncommon groin hernias: A possible source of persistent pain after successful repair

“…Reports of concurrent multiple groin hernias are rare and limited to cases reporting three groin hernias in one patient [15], [16]. We believe that this case report of a patient with six concurrent groin hernias, is the first in the literature.…”

“…The anterior approach however is not able to address any coexisting occult hernias. Laparoscopic intraperitoneal onlay mesh repair is reported but may leave unnoticed and untreated extraperitoneal herniations [16]. During laparoscopic TAPP and total extraperitoneal (TEP) hernia repair, all the possible rare hernia sites are examined and mesh is placed with an adequate overlap of all the hernia defects [4], [8], [9], [11], [13], [15].…”

A Case of bilateral concomitant inguinal and femoral hernias treated with transabdominal preperitoneal repair

“…The present case was an extremely rare one as simultaneous bilateral inguinal and femoral hernias were observed. Reports of three or more simultaneous hernias are very few, [10][11][12] and to the best of our knowledge, this is the first report of both bilateral inguinal and femoral hernias. Strangulation or incarceration is the chief complaint for femoral hernias.…”

A Case of bilateral concomitant inguinal and femoral hernias treated with transabdominal preperitoneal repair

“…The present case was an extremely rare one as simultaneous bilateral inguinal and femoral hernias were observed. Reports of three or more simultaneous hernias are very few, 10,11,12 and to the best of our knowledge, this is the first report of both bilateral inguinal and femoral hernias. Strangulation or incarceration is the chief complaint for femoral hernias.…”