PMC5410610_01
Explorative laparoscopy of the left groin for re-recurrence following TAPP and Lichtenstein operation.
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F1
Then once again the patient experienced symptomatic recurrence. To confirm the diagnosis and assist in preoperative management we first carried out explorative laparoscopy, which revealed a medial re-recurrence with inadequate dissection and mesh placement at the time of primary repair in TAPP technique (Figures 1 and 2).
Good visualization of the medial re-recurrence following TAPP and Lichtenstein operation (left groin).
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F2
Then once again the patient experienced symptomatic recurrence. To confirm the diagnosis and assist in preoperative management we first carried out explorative laparoscopy, which revealed a medial re-recurrence with inadequate dissection and mesh placement at the time of primary repair in TAPP technique (Figures 1 and 2).
Following incision of the peritoneum above and below the incorrectly positioned mesh, dissection of the left groin.
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F3
Since we were easily able to perform dissection above and below the inadequately fitted mesh, re-TAPP was conducted (Figure 3).
Placement of a mesh measuring 10 cm x 15 cm (TiMesh light, pfm medical, Cologne) and fixation of the superior margin with absorbable tackers (SecureStrap, Ethicon, Norderstedt) (left groin).
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F4
It was possible to fit a mesh measuring 15 x 10 cm (TiMesh light) on completion of dissection (Figure 4).
Placement of a drain between the abdominal wall and peritoneum and closure of the peritoneal defect with a continuous suture (left groin).
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F5
After placement of a drain between the mesh and the peritoneum, the peritoneum was closed with a suture (Figure 5).
PMC5410610_02
Explorative laparoscopy of the left groin for re-recurrence following TAPP and Lichtenstein operation as well as robotic radical prostatectomy.
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F6
The latter revealed extensive adhesions in the region of the left groin (Figure 6) after radical prostatectomy, which ruled out repeat overview dissection of the left groin in laparoscopic technique.
Repair of medial re-recurrence after TAPP and Lichtenstein operation with a plug (left groin).
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F7
The medial recurrence was exposed and repaired in plug technique (Figure 7).
PMC5410610_03
Explorative laparoscopy for re-recurrence after TAPP and Shouldice operation (right groin).
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F8
Explorative laparoscopy showed widespread adhesions of the cecum to the TAPP repair region (Figure 8).
Extensive lipoma and additional hernia sac identified during open re-recurrent operation (right groin).
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F9
It was decided to perform open Lichtenstein operation, which revealed a large lipoma in the region of the spermatic cord structures (Figure 9); this was excised and resected.
Closure of the lateral re-recurrent hernia in Lichtenstein technique (right groin).
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F10
Next Lichtenstein operation was carried out (Figure 10).