PMC5536818_01
Laparoscopic findings of the right inguinal region during the first surgery.. (A) Dense adhesions between the cecum and anterior abdominal wall were observed.. (B) There was a peritoneal defect after the lysis of adhesions. The area enclosed by the yellow dotted line indicates the peritoneal defect. The black asterisk shows the cecum. Blue arrowheads show testicular arteriovenous.. (C) Laparoscopic findings after IPOM repair.
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On the right side, a direct inguinal hernia was observed, but dense adhesions between the cecum and anterior abdominal wall due to previous appendectomy were observed (Fig. 1A). After lysis of adhesions, the peritoneum of the inguinal area was defect (Fig. 1B). On the dorsal side, which included the triangle of pain area, the mesh was fixed to connective tissues with several absorbable sutures (Fig. 1C).
The area of pain and numbness.. The area enclosed by the black line indicates the area of pain and numbness.
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However, at his postoperative month 1 follow-up, he presented with severe pain and numbness distributed from the right inguinal region to the inner thigh region (Fig. 2).
Laparoscopic findings in the second surgery.. (A) After the lysis of adhesions, we confirmed a contracted mesh. A white asterisk shows the contracted mesh. The black asterisk shows the cecum.. (B) Laparoscopic findings of a contracted mesh involving nerve branches. Black arrowheads indicate nerve branches. The white asterisk shows the contracted mesh.. (C) Laparoscopic findings after the nerve dissection. Black arrowheads indicate the proximal stump of the dissected nerves.
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On laparoscopic exploration, the contracted mesh was found and it involved several nerve branches (Fig. 3A and B). These nerves were ligated proximally and then cut off distally (Fig. 3C).