2 CASE REPORT

The patient was a man in his 80s with no remarkable medical or family history. He presented at our emergency department with swelling and pain in the right groin. The right groin showed a swelling of 10 × 10 cm. Vital signs and blood tests were normal at the visit. Abdominal contrast-enhanced CT showed prolapse of the small intestine into the right groin (Fig. 1). The hernia was located outside the inferior abdominal wall artery, suggesting an indirect hernia. The size of the hernia gate was 3 × 2 cm. The left side did not show any apparent hernias. On confirming that there was no apparent intestinal ischemia, manual return was performed and the patient was hospitalized for observation. He was discharged 3 days later, after confirmation that there were no complications such as intestinal ischemia. It was agreed upon that surgery would be performed at a later date on a watch-and-wait basis. TAPP was used to repair it. The operation was performed in a supine position under general anesthesia. On placing the 12-mm port in the umbilicus using the open method and examining the abdominal cavity, the coexistence of a femoral hernia as well as an indirect inguinal hernia was observed on the right side. Further observation of the left side also revealed an indirect inguinal as well as a femoral hernia (Fig. 2). Although the patient was asymptomatic, surgery was also indicated for the left side, and a simultaneous repair was then performed. Two 5-mm ports were placed in the left and right abdomen, respectively, and the operation was performed with three ports in total. The first repair was performed on the right hernia. The peritoneum was linearly incised from the outside of the hernia tract toward the hernia tract, and the space between the peritoneum and the preperitoneal fat was separated to form a space for placing the mesh. Exfoliation was performed to include the thigh ring. The inside was sufficiently dissected up to the rectus abdominis muscle, and the outside was sufficiently dissected to the right upper iliac spine. Thereafter, a Bard 3D Max Light ® mesh (10 × 15 cm) was placed and fixed to cover the inner inguinal ring, Hesselbach’s triangle, and thigh ring completely. The incised peritoneum was surgically closed with 3-0 Vicryl sutures. The left hernia was repaired using the same procedure (Fig. 2). The postoperative progress of the patient was good, and he was discharged 2 days later. No complications or recurrence have been reported for 3 years since the surgery.