Coexistence of Right Obturator, Lacunar, Direct Inguinal, Bilateral Indirect Inguinal, and Bilateral Femoral Hernias and
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IMAGES IN SURGERY
Coexistence of Right Obturator, Lacunar, Direct Inguinal, Bilateral Indirect Inguinal, and Bilateral Femoral Hernias and Treatment with Totally Extraperitoneal Laparoscopy M. Ates 1
&
F. Ciftci 1
&
E. Sahin 1
&
K. B. Sarici 1
Received: 23 June 2020 / Accepted: 29 October 2020 # Association of Surgeons of India 2020
Abstract The majority of groin hernias are treated according to the findings of the physical examination, but patients may also have occult hernias. With the use of laparoscopy, hernias that were not noticed during the initial examination or even in radiological images are increasingly being detected intraoperatively. Here, we present the case of a 62-year-old gentleman diagnosed with seven different types of occult and non-occult bilateral inguinal hernias that were treated with laparoscopic totally extraperitoneal herniorrhaphy. A major advantage of this method is that it allows the simultaneous diagnosis and treatment of occult and rare inguinal hernias. Keywords Multiple inguinal hernias . Contralateral occurrence . Laparoscopic surgery . TEP
Case Report and Introduction A 62-year-old gentleman was admitted with testicular pain of 1-month duration. Ultrasound revealed a right indirect inguinal hernia. Laparoscopic TEP hernia repair was performed. Exploration of the right inguinal area revealed the indirect and direct inguinal, lacunar, classic femoral, and right obturator hernia (Fig. 1). The patient’s left inguinal area was also dissected based on the results of previous research performed in our clinic on the inguinal region vascular anatomy [1]. Left indirect inguinal hernia and left femoral hernia were detected (Fig. 1). Bilateral myopectineal orifices were covered using polypropylene mesh. A rare and occult hernia is defined as a hernia that is detected by imaging or during surgical dissection but not by physical examination [2]. During conventional inguinal hernia repair, an accompanying occult hernia may be difficult to be detected, due to the narrow surgical field [2]. However, the use of totally extraperitoneal (TEP) laparoscopy for inguinal
* E. Sahin [email protected] 1
Department of General Surgery, Turgut Ozal Medical Center, Inonu University Faculty of Medicine, Malatya, Turkey
hernia repair can reveal an otherwise occult hernia in the pelvic or inguinal region.
Discussion In patients undergoing unilateral laparoscopic inguinal hernia repair, an occult inguinal hernia on the non-suspicious side is detected in 11–28% of cases, and an occult femoral hernia in 9.2% [3]. The prevalence of rare hernias is not fully known. However, Koch et al. reported that, in a series of patients requiring emergency inguinal hernia repair, additional hernias outside the inguinal or femoral canal were found in 9.7% of cases [4]. Another study reported occult hernias in 22–33% of patients who underwent laparoscopic femoral hernia repair [5]. A lacunar hernia (Laugier, Gimbernat) develops in the opening of the lacunar ligament, and a Cloquet hernia (Callisen-Cloquet) in th
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