Reply To: Recurrence Procedure

[LeviProcter]

I can email you an article on this if you’d like.

Here is the abstract:

Missed lipoma of the spermatic cord A pitfall of transabdominal preperitoneal laparoscopic hernia repair K. S. Gersin, B. T. Heniford, A. Garcia-Ruiz, J. L. Ponsky Minimally Invasive Surgery Center, Department of General Surgery, Cleveland Clinic Foundation, Department of General Surgery/A80, 9500 Euclid Avenue, Cleveland, OH 44195, USA Received: 22 July 1998/Accepted: 22 September 1998

Abstract

Background: Missed lipoma of the spermatic cord is a pitfall unique to the transabdominal preperitoneal (TAPP) laparoscopic hernia repair. This problem occurs when a palpable inguinal mass is noted preoperatively, but no identifiable hernia defect is found at time of laparoscopy and the procedure is terminated.

Methods: Our group encountered six patients without intraperitoneal defects that had large cord lipomas on preperitoneal exploration. Two of these patients had undergone previous intraabdominal laparoscopy for a proposed TAPP repair, which was aborted when no defect was seen.

Results: Both patients were referred for continued symptomatic groin masses, which were subsequently treated by lipoma resection in conjunction with inguinal floor repair.

Conclusions: When patients present with a groin mass, exploration of the preperitoneal space and cord structures is indicated during TAPP repair, even in the presence of a normal-appearing abdominal floor. Abandoning a transabdominal approach without exploration of the preperitoneal structures may lead to a failure to identify symptomatic and/or palpable cord lipomas.