Occult Para-Psoas Hernia during Routine Endoscopic Totally Extraperitoneal Inguinal Hernia Repair

BACKGROUND AND OBJECTIVES: Advantage of the total extraperitoneal (TEP) technique over open inguinal hernia repair allows for exploration of other anatomical regions in search for occult hernias (OH). METHODS: Our institutional practice is to routinely explore the obturator and femoral regions for occult hernias. In addition to this technique, we routinely expose the psoas muscle extensively to perfect mesh placement followed by fibrin glue fixation on both ‘triangles of doom and pain’. The use of this technique has led to the identification of three incidental occult para-psoas hernias (PPH) out of a total of 800 TEP repairs performed in a high-volume specialist hernia center. CONCLUSIONS: The purpose of this article is to demonstrate that occult parapsoas hernias (PPH) can be easily identified and safely repaired with mesh glue fixation, using the standard TEP technique during inguinal hernia repair.