Surgical technique of laparoscopic hybrid approach for recurrent inguinal hernia: Report a case

INTRODUCTION: Currently, laparoscopic surgery (LS) is a widely accepted surgical treatment for inguinal hernias, and it has major advantages, especially for recurrent cases. PRESENTATION OF CASE: We diagnosed the recurrent inguinal hernia after wound infection and performed the laparosocopic approach. We would like to introduce our method. < [Image: see text] First step: TAPP part> We distinguished between the presence and absence of bilateral inguinal hernia with an intra-abdominal scope using the transabdominal preperitoneal inguinal hernia repair (TAPP) technique, which we call laparoscopic examination. Thus, we can distinguish between the types of inguinal hernias and whether they are bilateral or not. < [Image: see text] Second step: totally extraperitoneal (TEP) part> We dissected the Retzius space on the inside of an epigastric arteriovenous fistula as part of TEP part A, and dissection was performed without a balloon. We separated and dissected the Retzius space. We also performed lateral dissection of the preperitoneal space. < [Image: see text] Third step: TAPP part > We made an incision in the peritoneum at the inner groin ring (hernia sac). We isolated the cord structures (parietalization) using TAPP. < [Image: see text] Final step: TAPP part> We finally checked this operation from the abdominal space (TAPP filed) and determined whether the repair was satisfactorily completed or not. DISCUSSION: Our hybrid method is not special but the conventional laparoscopic approach adapted each merits both TAPP and TEP. CONCLUSION: Our method is effective for difficult recurrent inguinal hernias. [Figure: see text]