Adam Truong, MD, MS, Shirin Towfigh, MD. Cedars Sinai Medical Center
Inguinal hernia repairs are amongst the most common surgery done worldwide and an increasing amount are done laparoscopically. Chronic postoperative inguinal pain is common and postoperative mesh infection is disastrous; each require explantation of mesh. We advocate for a minimally invasive approach with a robotic approach being superior to laparoscopic in morbidity and outcomes. We present a step by step guide that is applicable to both laparoscopic and robotic retroperitoneal inguinal mesh removal. This includes adequate preoperative preparation and workup. We feel a CT or MRI offers invaluable information for planning the surgery. With proper positioning, Foley placement, and applying sterile preparation to the scrotum in males the patient is optimized. We adhere to a strict order of steps and landmark identification to avoid injury to critical structures. We start medial to the anterior superior iliac spine, then progress superomedially, keeping the inferior epigastric vessels deep. The medial mesh edge is freed before progressing inferiorly. The final mesh attachments are released after the peritoneum is stripped from the mesh allowing proximal identification of critical structures. After repair of the hernia with new mesh, we reapproximate the peritoneum. We feel that mesh may be left on vessels or nerves if dissection has proven dangerous with the explicit understanding that mesh-related pain may follow with any amount of mesh, regardless of location. This is particularly important if the indications for the operation was chronic mesh-related pain. We believe this video guide will help the general surgeon accomplish retroperitoneal mesh removal safely.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87557
Program Number: V001
Presentation Session: Hernia Session
Presentation Type: Video