Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea.

ABSTRACT

Background and Objectives: In patients with inguinal hernias who have undergone radical prostatectomy, dissecting the medial preperitoneal space is difficult because of the presence of fibrotic scars. It is also difficult to guarantee sufficient space for mesh implantation. We added laparoscopic iliopubic tract repair (IPTR) to transabdominal preperitoneal (TAPP) hernioplasty, and evaluated this for the treatment of inguinal hernias after radical prostatectomy

Methods: This retrospective study included 29 male patients with inguinal hernias after radical prostatectomy who underwent TAPP hernioplasty between January 1, 2015 and October 31, 2018. Laparoscopic IPTR was performed first, followed by TAPP hernioplasty.

Results: All patients had an indirect inguinal hernia. The mean time from radical prostatectomy to TAPP hernioplasty was 2.1 years (range, 0.3–11 years). In one patient, the peritoneal flap was insufficient, and the operation was performed using a dual-layer mesh. All other patients underwent conventional TAPP hernioplasty. The mean operation time was 42 min (range, 30–50 min), and the mean duration until return to normal activities was 8.4 days. There were two minor postoperative complications (one hematoma and one seroma). The mean follow-up period was 45.8614.0months (range, 22–67 months), and chronic pain or recurrence was not observed.

Conclusion: Adding laparoscopic IPTR to TAPP hernioplasty in patients with a history of radical prostatectomy is feasi- ble and safe, with a low risk of chronic pain and recurrence.

Key Words: Inguinal hernia, Hernioplasty, Prostatectomy, Laparoscopy.

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Department of Surgery, Veterans Affairs Central Iowa Health Care System, Des Moines, IA, USA (Dr. Staab). Surgery Residency Program of the Iowa Methodist Medical Center, Des Moines, IA, USA (Dr. Welander).

ABSTRACT

Minimally invasive surgical technology is changing the management of spigelian hernias. In addition to open repairs, laparoscopic transabdominal repairs as well as laparoscopic totally extraperitoneal repairs are well documented. However, because spigelian hernias are uncommon, few surgeons have a large volume of experience with spigelian hernia repairs. This is particularly true of the repair of spigelian hernias with concurrent inguinal and femoral hernias. We provide intraoperative images of bilateral spigelian and inguinal and femoral hernias repaired via a laparoscopic totally extraperitoneal approach. This patient was successfully treated with a single piece of mesh on each side. The single mesh piece on the right repaired the right spigelian hernia and a femoral hernia. The single mesh piece on the left repaired the spigelian hernia and left direct and indirect inguinal hernias. Preoperative computed tomography scans illustrate the close proximity of the spigelian defects and the inguinal defects that allow the use of a single 10 15-cm mesh piece for repair of each side. Our goal is to provide intraoperative images to allow a surgeon who is experienced with totally extraperitoneal repairs to visualize this operation and apply this approach to other patients with concurrent spigelian and inguinal or femoral hernias.

Key Words: Spigelian hernia, Laparoscopic, Minimally invasive surgery, Totally extraperitoneal repair, Inguinal hernia, Femoral hernia, Mesh repair.

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The post Intraoperative Images of the Totally Extraperitoneal Repair of Concurrent Spigelian and Groin Hernias first appeared on CRSLS.