Evaluation of Laparoscopic Management of Inguinal Hernia Without Peritoneal Sac

P C Munipalle, T Garud, Y K S Viswanath

South Tees Hospitals NHS Foundation Trust

Introduction
It has been noticed with the advent of laparoscopic repair of inguinal hernia that there is a category of patients experiencing groin pain and or lump due to protrusion of extraperitoneal fat into the inguinal canal in the absence of demonstrable peritoneal sac. We present a series of such cases in patients undergoing Laparoscopic Trans Abdominal Pre- Peritoneal (TAPP) repair and discuss their symptoms, management and follow up.

Methods
A total of 92 TAPP laparoscopic repairs were carried out in 65 patients in a single unit over the period of 4 years. They were studied prospectively to evaluate those cases with significant groin lump related symptoms and no demonstrable peritoneal sac. In those patients with groin symptoms suggestive of a hernia but no clear physical findings, ultrasound or MRI where appropriate has been performed. These patients have been followed up in terms of improvement in symptoms and recurrence of hernia.

Results
Among 92 consecutive laparoscopically repaired inguinal hernias, 11 hernias in 10 patients were found not to have demonstrable peritoneal sac. Two hernias had lump with expansile cough impulse, two had groin pain and the remaining 7 had both expansile lump and groin pain. All these patients were treated by excision of the ‘lipoma’ and placement of a mesh preperitoneally. Patients’ symptoms improved significantly in all the patients till to date. None of them had a recurrence over a median follow up period of 4 years.

Conclusions
A proportion of patients presenting with groin pain/ with or without expansile groin lump will have an extra peritoneal fat herniation with no demonstrable peritoneal sac. The symptoms could be explained by the protrusion of extra peritoneal fat (‘lipoma’) in to the inguinal canal causing ‘Inguinal compartment syndrome’. Clinical awareness and targeted treatment will help in resolution of symptoms.

Session: Podium Presentation

Program Number: S021