LAPAROSCOPIC DIAGNOSIS AND TREATMENT OF A COMPLEX INCISIONAL INGUINAL HERNIA

Jonah White, MD, Jeffrey Chiu, MD, Bernadette Profeta, MD, Francisco Couto, MD, Alexandros Coutsoumpos, MD, Rachael Gentry, PAC, Scott Bloom, MD, Steve Eubanks, MD. Florida Hospital

A 59-year-old male had previously undergone percutaneous coronary artery revascularization with access through the right femoral artery. He subsequently required a right femoral endarterectomy with right femoral to popliteal bypass due to occlusive disease and chronic right femoral artery dissection as a complication of femoral access from his coronary artery catheterization. The patient developed graft occlusion 3 years later and required revision and replacement of the femoral to popliteal bypass graft. The patient had a moderate sized, soft, reducible, right groin hernia on physical exam. CT scan demonstrated a right femoral hernia containing several loops of small bowel without any evidence of bowel obstruction. The patient was subsequently offered laparoscopic right femoral hernia repair with mesh with posterior approach due to multiple open procedures in the anterior groin. Intraoperatively, he was found to have a right inguinal hernia lateral to the inferior epigastric vessels secondary to dilation of the indirect space from his previous femoral artery procedures instead of a true femoral hernia. The hernia defect was repaired with the laparoscopic intraabdominal posterior approach using prosthetic mesh without complication. This case demonstrates the usefulness of laparoscopic posterior approach in the repair of a complex groin hernia as an alternative to anterior approach, which would have been complicated by the assumption of a true femoral hernia on this patient’s CT scan.