A case of recurrent inguinal hernia repaired using the “contralateral approach” during the trans-abdominal pre-peritoneal approach (TAPP) Naoki IKENAGA 1 , Ryo MAEYAMA 1 , Hiroyuki KONOMI 1 , Hitoshi ICHIMIYA 1 1Department of General Surgery, Hamanomachi Hospital Keyword: 腹腔鏡下ヘルニア修復術 , 鼠径ヘルニア , 対側アプローチ pp.551-555
Published Date 2018/7/15
DOI https://doi.org/10.11477/mf.4426200586
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We used the “contralateral approach” during the trans-abdominal pre-peritoneal approach (TAPP) to repair a recurrent inguinal hernia. A 47-year-old man developed left recurrent inguinal hernia 2 years after direct Kugel repair for a left direct inguinal hernia. He also had a right primary inguinal hernia and underwent TAPP repair. Laparoscopy revealed a 2-cm hernial orifice on the ventral and pubic side of the old direct Kugel patch, which was illuminated through the peritoneum at the left inguinal region (Ⅱ-1-Rec). At the right inguinal region, a direct inguinal hernia was observed (Ⅱ-2). We cut the right inguinal peritoneum, expanded the pre-peritoneal space, and identified the right hernial orifice according to the standard TAPP method. We proceeded to the left side through the supravesical preperitoneal space from the right side and exposed the left inguinal hernial orifice. We used Bard 3D Max® mesh to cover the bilateral hernial orifices and tacked it at the transversus abdominis aponeurosis, rectus abdominis muscle, and direct Kugel patch. The opening of the peritoneum was closed with running 3-0 absorbable sutures. The “contralateral approach, which utilizes the non-adhesive area for access to the adhesive hernial orifice in cases of recurrent hernia, is a novel and useful technique.

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