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.