Laparoscopic repair of femoral hernia involving the bladder with coexisting indirect inguinal hernia in a young man: a case report

Abstract Background Bladder hernias are rare conditions that are difficult to diagnose preoperatively; many cases are diagnosed intraoperatively or postoperatively due to bladder injury. Most bladder hernias are direct inguinal hernias that involve the bladder in obese men older than 50 years old. We describe a rare case of a left femoral hernia involving the bladder in a young man. Case presentation A 32-year-old man with a bulge in the left inguinal region underwent laparoscopic transabdominal preperitoneal repair. Laparoscopy revealed a left indirect inguinal hernia. When the preperitoneal space was dissected toward the Retzius space along the vesicohypogastric fascia, the bladder was found to be protruding into the femoral ring and adhere to the hernial orifice severely. The bladder was reduced carefully without causing injury. After dissection, we repaired the left myopectineal orifice with a mesh. The patient was discharged on postoperative day 1 without complications. No recurrences or symptoms were noted at the 12-month follow-up. Conclusions A femoral hernia involving the bladder in a young man is rare. This case demonstrated that dissection along anatomical landmarks is important for preventing injuries to the bladder because even young men may have bladder hernias.

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Non-Descended Testicle Presenting as an Inguinal Hernia

Surgical Case Reports ◽

10.31487/j.scr.2020.01.10 ◽

2020 ◽

pp. 1-2

Author(s):

Wouter J Bakker ◽

C. V. van Hessen ◽

J. P. J. Burgmans ◽

W. D. Rinkel ◽

Wouter J Bakker

Keyword(s):

Inguinal Hernia ◽

Groin Pain ◽

Undescended Testis ◽

Inguinal Canal ◽

Preperitoneal Space ◽

Indirect Inguinal Hernia ◽

Left Testis ◽

Left Groin ◽

Case Presentation ◽

Adult Men

Background: An inguinal hernia is one of the most common surgical diagnosis worldwide and the most frequent anomaly of the groin area. Cryptorchidism, the failure of the testes to descend into the scrotum, is also a prevalent congenital abnormality, with a reported incidence of 1% to 2% at 12 months of age. However, it is rarely diagnosed in adult men. Case Presentation: We present the case of a 63-year-old male who presented to the Emergency Department with severe left-sided groin pain since a couple of days. A bulge in the left groin was visibly obvious and was painful but reducible. An inguinal hernia was diagnosed, and since the patient had no previous (abdominal) surgery, he was scheduled for a totally extraperitoneal (TEP) endoscopic inguinal hernia repair. Per-operatively, an indirect inguinal hernia was initially seen; however, after further dissection and displacement of the peritoneal fold cranially, it became clear that the alleged hernia was the left testis situated in the preperitoneal space. The testis was surgically brought out through the inguinal canal. A preperitoneal mesh was placed. Conclusion: In case of a painful and reducible inguinal swelling that occurs in a patient with an empty hemiscrotum, surgeons must consider the possibility of an undescended testis.

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Incarcerated Femoral Hernia Repair with Ventralex™ Hernia Patch through Same Skin Incision and Suprainguinal Laparotomy

Case Reports in Surgery ◽

10.1155/2018/9719310 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

David Aranovich ◽

Veacheslav Zilbermints ◽

Oleg Kaminsky

Keyword(s):

Hernia Repair ◽

Femoral Hernia ◽

Bowel Resection ◽

Abdominal Cavity ◽

Skin Incision ◽

Operative Approach ◽

Easy Access ◽

Midline Laparotomy ◽

Femoral Ring

Purpose. To report our experience with incarcerated femoral hernia procedure, which allows laparotomy through same inguinal skin incision, inspection and resection of compromised bowel, and preperitoneal tension-free transabdominal repair with Ventralex™ Hernia Patch.Materials and Methods. The suprainguinal laparotomy was performed via same groin incision without compromising iliopubic tract. The femoral ring was sealed with Ventralex™ Hernia Patch pulled through the abdominal cavity and secured outside. Five consecutive patients diagnosed with incarcerated femoral hernias were operated. All of them required laparotomy, either for bowel resection (n=3) or for inspection of viability (n=2).Results. All patients tolerated the procedure well. There were no wound or mesh infections, incisional hernias, or recurrences during follow-up.Conclusions. Our easy-to-master operative approach to incarcerated femoral hernia allows easy access to abdominal cavity through same groin incision without compromising iliopubic tract or midline laparotomy. Reduction of incarcerated bowel and its inspection and resection can be safely performed. The femoral ring defect can be effectively obliterated with Ventralex™ Hernia Patch.

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The results of preperitoneal inguinal hernioplasty without fixation of the mesh endoprosthesis in the experiment.

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2019-12-2-97-101 ◽

2019 ◽

Vol 12 (2) ◽

pp. 97-101

Author(s):

Anna Viktorovna Mokrova ◽

Oleg Vladimirovich Zaitsev ◽

Dmitry Anatolyevich Khubezov ◽

Vladimir Alexandrovich Yudin ◽

Sergey Vasilevich Tarasenko ◽

...

Keyword(s):

Inguinal Hernia ◽

Inguinal Canal ◽

Abdominal Cavity ◽

Preperitoneal Space ◽

Indirect Inguinal Hernia ◽

Inguinal Hernioplasty ◽

Experimental Development ◽

Direct Inguinal Hernia ◽

Significant Difference ◽

Mesh Endoprosthesis

The purpose of the study is experimental development of preperitoneal inguinal hernioplasty with synthetic mesh, according assessment of the need of its fixation to the tissues. Materials and methods. An inguinal hernia was simulated on human cadaveric material. The study used 27 male corpses. Two inguinal hernias were modeled on one corpse: on one side - indirect, on the other - direct. A polypropylene mesh (standard density, 15 x 15 cm) was placed in the preperitoneal space. The endoprosthesis was impacted from the side of the abdominal cavity by a special designed device. The effect of a peak intra-abdominal pressure of 200 mm Hg was simulated. The degree of displacement of the reticular endoprosthesis into the inguinal canal was estimated at the moment of peak pressure on it from inside the abdominal cavity. For a simulated indirect inguinal hernia, two variants of the technique were considered: with fixation of the endoprosthesis to the underlying tissues and without fixation. For the modulated direct inguinal hernia, the following options were considered: non-fixative, with fixation at one point to the pubis and with plasty of the transverse fascia. Results. When modeling preperitoneal plasty of a direct inguinal hernia, there is a pronounced displacement of the endoprosthesis into the inguinal canal with a non-fixing plasty, unlike the method with transverse fascia plasty or fixation to the pubis. In indirect inguinal hernia, there was no significant displacement of the endoprosthesis in both considered variants. Conclusions. According to the obtained results, conclusions were drawn on the need for additional plasty of the transverse fascia or fixation of the endoprosthesis at a single point in a direct inguinal hernia. With indirect inguinal hernia in the experiment, no significant difference in the displacement of the mesh endoprosthesis into the inguinal canal was obtained with and without fixation.

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INGUINAL HERNIA REPAIR;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.06.2251 ◽

2014 ◽

Vol 21 (06) ◽

pp. 1144-1146

Author(s):

Iftikhar Ahmed Bhatti

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Prosthetic Mesh ◽

Indirect Inguinal Hernia ◽

Female Ratio ◽

Male Female Ratio ◽

Group A ◽

Group B

Objective: To compare the results of Inguinal Hernia repair using commonly employed methods of Bassini’s and Mesh repair. Methodology: This study included 90 cases of hernia repair ranging over a period of 18 months from October 2008 to Mar 2010 at Social Security Hospital Lahore. All the cases were done by the consultants and senior surgeons. The methods of repair included Bassini’s and Hernioplasty with Prosthetic mesh. Results: Out of 90 patients, 88 were males (97.78%) and 02 were females (2.22%). Male – female ratio 45 : 1. The peak incidence was found in 3rd and 4th decades of life. 56(62.22%) had Rt.sided Inguinal hernia, 29 (32.22%) had Lt. sided and 5(5.56%) had bilateral Inguinal hernia. 72 patients (80%) had Indirect Inguinal hernia, 17 (18.89%) had direct inguinal hernia while 1(1.11%) had both types. All the cases were done under Spinal anaesthesia. The Bassini’s repair was performed in 50% cases, using non-absorble no. 1 Prolene interrupted suturing (Group- A). In the Group – B, 50% cases underwent Hernioplasty with prosthetic prolene mesh 6x11 cms. Post-operative follow up was done for a period of 01 year. In the group- A, 3 (6.67%) patients had recurrence and 3 (6.67%) had infection of the wound. In group – B, 01 patient (2.22%) got infected and none of the cases did not get recurrence over a period of 01 year. Conclusions: Hernioplasty with prosthetic mesh is a better treatment modality for inguinal hernia repair to get a low recurrence rate.

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Pantaloon Hernia in a Female: A Rare Finding

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.727 ◽

2021 ◽

Vol 3 (2) ◽

pp. 1-2

Author(s):

Onyeyirichi Otuu ◽

Uche Emmanuel Eni ◽

Callistus Ugochukwu Ndunaka ◽

Nwanneka Louisa Kwentoh

Keyword(s):

Inguinal Hernia ◽

Correct Diagnosis ◽

Posterior Wall ◽

Uneventful Recovery ◽

Indirect Inguinal Hernia ◽

Left Groin ◽

Epigastric Artery ◽

Appropriate Treatment ◽

Groin Swelling

The incidence of inguinal hernia in females is less compared to the males. Pantaloon hernia in females is even rarer and may be first diagnosed during surgery. We report a rare case of pantaloon hernia in a 60 year old female patient. She presented with reducible left groin swelling of 3 years duration and a clinical diagnosis of an indirect inguinal hernia made. A direct sac and an indirect sac were discovered at operation on both sides of the inferior epigastric artery. The posterior wall was repaired by Lichtenstein method. Patient made an uneventful recovery and there was no recurrence after 12 months of follow up. Though pantaloon hernia is rare in females, proper dissection, and identification of structure in the inguinal canal is necessary to make the correct diagnosis and to offer the appropriate treatment.

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Prospective comparison of post-operative quality of life (QOL) after laparoscopic total extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) repair of indirect inguinal hernia

International Surgery Journal ◽

10.18203/2349-2902.isj20183208 ◽

2018 ◽

Vol 5 (8) ◽

pp. 2882

Author(s):

Nikita Wadhwani ◽

Ishwar Chand Mehar ◽

Arun Singh ◽

R. K. Soni

Keyword(s):

Quality Of Life ◽

Inguinal Hernia ◽

P Value ◽

Indirect Inguinal Hernia ◽

Statistical Significant Difference ◽

Tapp Repair ◽

Significant Difference ◽

Operative Quality

Background: As the laparoscopic method is becoming a popular choice of repair, the need to evaluate its impact on the patient’s quality of life (QOL) is also warranted. This study was undertaken to compare post operative QOL in patients undergoing Totally Extraperitoneal (TEP) and Transabdominal preperitoneal (TAPP) repair for indirect inguinal hernia.Methods: This prospective observational study was conducted in the Department of General Surgery at VMMC and Safdarjung Hospital, from June 2016 to March 2018. Patients with uncomplicated indirect inguinal hernia were included in the study after obtaining their informed consent. Post-operative QOL was evaluated using EuraHS-QOL scale at 24 hours and 1, 3 and 6 months after the surgery.Results: A total of sixty patients were enrolled-30 in TEP group and 30 in TAPP group. There was no statistical significant difference in scores at 24 hours follow-up except cosmetic discomfort domain, with higher scores in TAPP (p-value=0.014). Statistical significant difference was present at 1 month follow up with higher scores in TAPP (p-value=0.011). At 3 and 6 months, no statistical difference was found in the scores.Conclusions: Present study demonstrates a significant advantage of TEP over TAPP up to 1-month follow-up, in terms of post-operative QOL. Choosing a superior laparoscopic method between TEP and TAPP requires high powered RCTs with long term follow up to assess the technical advantages and post-operative complications along with post-operative quality of life in patients.

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An Improved Method for Deploying the Polypropylene Underlay Patch of the PROLENE Hernia System

The American Surgeon ◽

10.1177/000313480707300510 ◽

2007 ◽

Vol 73 (5) ◽

pp. 468-471

Author(s):

Yih-Huei Uen ◽

Kuo-Chang Wen

Keyword(s):

Inguinal Hernia ◽

Surgical Technique ◽

Hernia Repair ◽

Effective Treatment ◽

Femoral Hernia ◽

Anterior Approach ◽

Clinical Results ◽

Preperitoneal Space ◽

Improved Method ◽

Prolene Hernia System

The PROLENE Hernia System (PHS) is a bilayer patch device providing an anterior approach to preperitoneal inguinal hernia repair. To provide improved expansion of the underlay patch of PHS, a modified device featuring a deploying “pocket” in the double-layered underlay graft was designed. The deploying “pocket” is flat in shape and harbors a perimeter that can act as a receiving unit for surgical force, which is exerted outward and backward to expand the underlying graft. Through a unique surgical technique using an angled metal pusher to facilitate access to intrapocket manipulation, the underlay graft not only can be fully deployed, but can be securely placed in the preperitoneal space to cover the entire myopectineal orifice. This allows effective treatment of inguinal/femoral herniation. Based on the encouraging clinical results obtained using a procedure that incorporates this strategy at our hospital, it can be concluded that this modified device/technique for PHS is one of the best inguinal/femoral hernia repair methods available.

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Triorchidism: presenting as undescended testis in a case of indirect inguinal hernia

Clinics and Practice ◽

10.4081/cp.2016.786 ◽

2016 ◽

Vol 6 (2) ◽

Author(s):

Ajay H. Bhandarwar ◽

Saurabh S. Gandhi ◽

Chintan B. Patel ◽

Amol N. Wagh ◽

Virendra Gawli ◽

...

Keyword(s):

Inguinal Hernia ◽

Undescended Testis ◽

Vas Deferens ◽

Recent Literature ◽

Sperm Count ◽

Semen Analysis ◽

Indirect Inguinal Hernia ◽

Left Testis ◽

Ectopic Testis

Triorchidism is the commonest variety of polyorchidism, an entity with more than two testis is an extremely rare congenital anomaly of the testis. Although excision of the abnormal testis is a safer alternative proposed, recent literature suggests more conservative approach in normal testes with watchful regular follow up to screen for malignancy. This case presented as a left inguinal swelling diagnosed as indirect left inguinal hernia. The left side testis was of smaller size (about half) with normal sperm count, morphology and motility. Intraoperatively indirect inguinal hernia was noted with supernumerary testis at deep ring in addition to normal left testis in left scrotal sac. The ectopic testis were small (2.5×2.5×1 cm) lacking epididymis and with short vas deferens. An evident normal semen analysis and varied anatomy, the decision for orchidectomy of ectopic testis was taken. The histopathological finding was consistent with arrest in germ cell development.

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Strangulated Femoral Hernia Turned to Be Peritoneal Cyst

Case Reports in Surgery ◽

10.1155/2012/528780 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Dionysios Dellaportas ◽

George Polymeneas ◽

Christina Dastamani ◽

Evi Kairi-Vasilatou ◽

Ioannis Papaconstantinou

Keyword(s):

Femoral Hernia ◽

Correct Diagnosis ◽

Mesenteric Cyst ◽

Inclusion Cyst ◽

Case Presentation ◽

Peritoneal Inclusion Cyst ◽

Femoral Ring ◽

Careful Exploration ◽

The Right ◽

Caucasian Female

Introduction. A peritoneal inclusion cyst is a very rare mesenteric cyst of mesothelial origin usually asymptomatic. A rare case of an 82-year-old white Caucasian female with a femoral hernia containing a large peritoneal inclusion cyst, mimicking strangulated hernia, is presented herein.Case Presentation. The patient was admitted to our hospital suffering from a palpable groin mass on the right, which became painful and caused great discomfort for the last hours. Physical examination revealed a tender and tense, irreducible groin mass. An inguinal operative approach was selected and the mass was found protruding through the femoral ring. After careful dissection it turned out to be a large unilocular cyst, containing serous fluid, probably originating from the peritoneum. McVay procedure was used to reapproximate the femoral ring. Histologic examination showed a peritoneal inclusion cyst.Discussion. Peritoneal inclusion cysts are usually asymptomatic but occasionally present with various, nonspecific symptoms according to their size. Our case highlights that high index of clinical suspicion and careful exploration during repair of a hernia is mandatory in order to reach the correct diagnosis about hernia’s contents.

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Laparoscopic treatment of inguinal hernia in female children – national experience

Lietuvos chirurgija ◽

10.15388/lietchirur.2021.20.37 ◽

2021 ◽

Vol 20 (1) ◽

pp. 20-26

Author(s):

Toni Risteski

Keyword(s):

Inguinal Hernia ◽

Open Repair ◽

Average Length ◽

Prospective Clinical Study ◽

Indirect Inguinal Hernia ◽

Group 4 ◽

Repair Materials ◽

Female Children ◽

The Mean

Background. Although, laparoscopic inguinal hernia repair in children is gaining ground as a safe, feasible, and popular method, still many pediatric surgeons continue to debate its safety, efficacy, and cosmesis in comparison with conventional open repair. Materials and methods. This was a prospective clinical study, that elaborated 98 female children aged 1–14 with clinically diagnosed indirect inguinal hernia. Equal proportions of 49 children were treated via laparoscopic (PIRS) either conventional open repair (OR). Outpatient clinic follow up was performed regardless of the type of the intervention, on the 7th day and 6 weeks after discharge. Results. The mean age of children in PIRS vs. OR group was 5.3±2.7 vs. 5.9±3.3 years. There was no significant differences between the groups related to age (p = 0.4221), weight (p = 0.5482), family history (p = 0.5377), and residency rural/urban (p = 0.3161). The average length of unilateral vs. bilateral PIRS repair (29.5±6.8 vs. 43.6±7.2 min) was significantly shorter than OR (44±4.2 vs. 97±8.1 min) for consequently p = 0.0023 vs. p = 0.00001. The post-operative hospitalization after PIRS repair was 14.1±3.1 hours and was significantly shorter compared to OR – 44±4.2 hours (p = 0.00001). In OR group, 4 (8.2%) children had postoperative nausea compared to none in PIRS group. Significantly bigger cosmetic satisfaction was found in PIRS compared to OM group (p = 0.0001). Conclusion. With due respect to OR as a gold standard, the proven advantages of PIRS are motivation for further improvement of this technique for the purpose of treatment of inguinal hernia of female children.

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