Background: Many surgeons disagree on the optimal method of repair for an inguinal hernia. Some surgeons believe that the plug and patch method of repair is a superior alternative to a straight Lichtenstein repair. A recent literature review however describes numerous complications from this method of repair including chronic pain, plug migration and enterocutaneous fistula formation. This video demonstrates the laparoscopic removal of an inguinal plug and patch mesh for chronic groin pain in a 21 year old thin and healthy female.
Technique: On initial laparoscopic inspection a large plug in her groin was visable. To begin the peritoneum was taken off the abdominal wall down to the level of the mesh. It was apparent that the mesh was densely adherent to the surrounding structures including the round ligament and the iliac vessels. It was necessary to skeletonize the iliac artery and vein to enable the mesh to be isolated. The plug and patch mesh were removed through the previous groin incision, and the remaining defect was closed laparoscopically.
Results: The patient did well from the procedure, and was discharged home the same day of surgery. She returned to clinic 2 weeks later reporting some mild, but improved discomfort with no signs of hernia recurrence.
Conclusion: This video demonstrates a complex laparoscopic dissection for removal of an inguinal plug mesh.
Session: Video Channel
Program Number: V070