World Journal of Laparoscopic Surgery

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VOLUME 14 , ISSUE 1 ( January-April, 2021 ) > List of Articles

CLINICAL TECHNIQUE

A Novel Technique Using Mesh to Repair a Recurrent Large Indirect Inguinoscrotal Hernia

Ho L Chong, Adnan Taib, Andrew N Wilson, Muhammad A Khan, Alexandrina Braniste, Ateeq Jamil, Ali Warsi

Citation Information : Chong HL, Taib A, Wilson AN, Khan MA, Braniste A, Jamil A, Warsi A. A Novel Technique Using Mesh to Repair a Recurrent Large Indirect Inguinoscrotal Hernia. World J Lap Surg 2021; 14 (1):65-67.

DOI: 10.5005/jp-journals-10033-1429

License: CC BY-NC 4.0

Published Online: 01-04-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Background: The positioning of a slit mesh around cord structures during laparoscopic transabdominal preperitoneal (TAPP) hernia repair rests the mesh better without kinks, thereby minimizing recurrences. However, studies also suggest that insufficient closure of the mesh slit may lead to recurrences. Aim: This report describes a novel technique using AbsorbaTacks (Covidien) to close the mesh slit and refashion an artificial ‘deep ring’ to minimize recurrence. Technique: We report the case of a fit 82-year-old Caucasian male presenting with a recurrent large right indirect inguinoscrotal hernia (8 x 8 × 7 cm with 4 × 4 cm deep inguinal ring). The patient underwent a TAPP repair with a background of unsuccessful open repair by another surgeon previously. Following mesh deployment, the mesh was lifted up by the cord structures, which was under tension due to a large defect. A slit was made in the inferomedial aspect of the mesh. This allowed it to be wrapped around the cord structures. The overlapped trouser flaps were then stapled together encircling the cord, by AbsorbaTacks to create a secure artificial ‘deep ring’. Edges of the mesh were also standardly affixed by AbsorbaTacks to the pectineal ligament and posterior abdominal wall. This creates a secure four-point fixation of the mesh scaffold to prevent ‘windsock’ effect, which happens when the mesh is pushed into the widened deep inguinal ring, leading to early recurrences. The peritoneal incision was also closed with AbsorbaTacks. Conclusion: No complications were registered during the early postoperative period. The patient had an uneventful recovery and was discharged within 20 hours with simple analgesia. No recurrence was reported during the 6 months follow-up period. Clinical significance: The anchoring of a slit mesh with tackers around the cord structures can be used to repair large recurrent inguinal hernias laparoscopically following an open repair. This technique potentially minimizes further recurrences.


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  1. Belyansky I, Tsirline VB, Klima DA, et al. Prospective, comparative study of postoperative quality of life in TEP, TAPP, and modified Lichtenstein repairs. Ann Surg 2011;254(5):709–715. DOI: 10.1097/SLA.0b013e3182359d07.
  2. Pawlak M, Tulloh B, de Beaux A. Current trends in hernia surgery in NHS England. AnnR Coll Surg Engl 2020;102(1):25–27. DOI: 10.1308/rcsann.2019.0118.
  3. Saber A, Hokkam EN, Ellabban GM. Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial. J Minim Access Surg 2015;11(2):123–128. DOI: 10.4103/0972-9941.153809.
  4. Bracale U, Melillo P, Pignata G, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 2012;26(12):3355–3366. DOI: 10.1007/s00464-012-2382-5.
  5. Saber A, Ellabban GM, Gad MA, et al. Open preperitoneal versus anterior approach for recurrent inguinal hernia: a randomized study. BMC Surg 2012;12(1):22. DOI: 10.1186/1471-2482-12-22.
  6. Campanelli G, Pettinari D, Nicolosi FM, et al. Inguinal hernia recurrence: classification and approach. Hernia 2006;10(2):159–161. DOI: 10.1007/s10029-005-0053-3.
  7. Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009;13(4):343–403. DOI: 10.1007/s10029-009-0529-7.
  8. Bracale U, Andreuccetti J, Sodo M, et al. Lack of advantages of slit mesh placement during laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP): a single-center, case-matched study. BMC Surg 2018;18(1):75. DOI: 10.1186/s12893-018-0409-0.
  9. Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004;350(18):1819–1827. DOI: 10.1056/NEJMoa040093.
  10. Fitzgibbons RJ, Puri V. Laparoscopic inguinal hernia repair. Am Surg 2006;72(3):197–206.
  11. Leibl BJ, Kraft B, Redecke JD, et al. Are postoperative complaints and complications influenced by different techniques in fashioning and fixing the mesh in transperitoneal laparoscopic hernioplasty? Results of a prospective randomized trial. World J Surg 2002;26(12):1481–1484. DOI: 10.1007/s00268-002-6204-0.
  12. Leibl BJ, Schmedt CG, Schwarz J, et al. A single institution's experience with transperitoneal laparoscopic hernia repair. Am J Surg 1998;175(6):446–452. DOI: 10.1016/S0002-9610(98)00074-9.
  13. Yang XF, Liu JL. Anatomy essentials for laparoscopic inguinal hernia repair. Ann Transl Med 2016;4(19):372. DOI: 10.21037/atm.2016.09.32.
  14. Velasco JM, Gelman C, Vallina VL. Preperitoneal bilateral inguinal herniorrhaphy. Surg Endosc 1996;10(2):122–127. DOI: 10.1007/BF00188356.
  15. Jonas J. The problem of mesh shrinkage in laparoscopic incisional hernia repair. Zentralbl Chir 2009;134(3):209–213. DOI: 10.1055/s-0028-1098779.
  16. Brown CN, Finch JG. Which mesh for hernia repair? Ann R Coll Surg Engl 2010;92(4):272–278. DOI: 10.1308/003588410X12664192076296.
  17. Claus C, Furtado M, Malcher F, et al. Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide. Surg Endosc 2020;34(4):1458–1464. DOI: 10.1007/s00464-020-07449-z.
  18. Celik AS, Memmi N, Celebi F, et al. Impact of slit and nonslit mesh technique on testicular perfusion and volume in the early and late postoperative period of the totally extraperitoneal preperitoneal technique in patients with inguinal hernia. Am J Surg 2009;198(2):287–291. DOI: 10.1016/j.amjsurg.2008.11.038.
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