Recurrence Procedure

[Lucky46]

Thanks the abstract is sufficient enough.

[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.

[Lucky46]

Thank you for your time and response Dr. Procter. Like I mentioned to Dr. Towfigh you guys ROCK! This forum,your time, information and the fact actual doctors read AND respond to our questions is priceless. Most other forums usually just “trail” off and leave forum members hanging.Thanks.

[LeviProcter]

Recurrence repair should be done by a hernia specialist.

Typically repeat repair is not done through same approach (typically). If an open repair is done and recurs then you approach via a posterior (MIS aka lap or robotic approach) and vice versa. That’s a basic tenet but not always applicable. It requires a lot of thought and risk assessment by the surgeon.