Laparoscopic transabdominal preperitoneal obturator hernioplasty with self-gripping mesh: A case report with operative video. (December 2021)

• Record Type: Journal Article
• Authors: Doden, Kenta; Yoshimura, Takahiro; Iwaki, Yoshitaka; Kato, Hideaki; Kawaguchi, Masahiko; Watanabe, Toru
• Is Part Of: International journal of surgery case reports. Volume 89(2021)
• Publication Date: 2021-12
• Subjects: CT computed tomography -- CRP C-reactive protein -- OH obturator hernia -- POD post-operative day -- TAPP transabdominal preperitoneal -- TEP totally extraperitoneal -- WBC white blood cell; Obturator hernia -- Self-gripping mesh -- TAPP; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.106657
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction: We investigated the effectiveness of a self-gripping mesh, which has microgrips attached to fibrous tissue, in laparoscopic transabdominal preperitoneal (TAPP) obturator hernia (OH) repair to minimize the risk of postoperative pain and obturator nerve injury. Presentation of case: The patient was an 80-year-old woman who was transferred to our emergency department with abdominal pain in the right lower quadrant and low back pain that began half a day prior to presentation. Computed tomography (CT) detected right OH. Based on the results of the laboratory examination and dynamic CT, intestinal viability was maintained. Ultrasonography-assisted manual reduction of the incarcerated intestine was performed, followed by admission to our department to check for delayed perforation of the intestine. Laparoscopic TAPP OH repair was performed on day seven as an elective surgery. A self-gripping mesh was placed over the OH defect and the femoral ring without tacking. The patient was discharged on postoperative day four, without any complications. Discussion: Tacking of the mesh at the lateral and dorsal sides of the obturator canal is dangerous due to the presence of the obturator nerve and vessels. Self-gripping mesh use in laparoscopic TAPP OH repair is a rational decision in terms of avoiding tacking or suturing around the obturator canal while maintaining stable fixation of the mesh to prevent recurrence. Conclusion: Laparoscopic TAPP OH repair with self-gripping mesh is a rational treatment option that reduces the risk of obturator nerve injury while maintaining the secure fixation of a mesh to prevent recurrence. Highlights: Laparoscopic obturator hernia repair with a self-gripping mesh gives successful results. Advantages include the lack of need for tacking the mesh and ensuring stable fixation. This is a rational option for obturator hernia repair.