Robotic Repair of a Multiply Recurrent Inguinal Hernia

Abstract Background This is a 62-year-old male with bilateral inguinal hernias (IH), the left being multiply recurrent after an open, anterior tissue-based approach 30 years ago and recently a robotic Transabdominal Preperitoneal Repair. He recurred within a year and was referred to our hernia center. Methods The patient underwent preoperative counselling, and we particularly discussed the risk of converting to an open approach if we could not safely carry out the dissection robotically. Results Upon entry, a recurrent left IH and primary right IH were noted. We incised the peritoneum across the abdominal wall and dissected medially, down to the pubis. Although this was a reoperative case, we successfully accessed the preperitoneal plane. On the left, we encountered the prior mesh, which appeared rotated medially and densely adhered to the inferior epigastric vessels, so the decision was made to leave it in place. The lateral preperitoneal dissection was completed, and the cord structures were dissected off the hernia sac. We repaired the contralateral defect following the same steps. The critical view of the myopectineal orifice was obtained bilaterally, and two pieces of mesh were introduced. Our mesh spanned two centimeters below the pubic tubercle and sat flush without the edges rolling. The mesh was secured at the pubic tubercle, Cooper’s ligament, medially, and at the lateral edge of the preperitoneal flap, protecting the neurovascular structures in the area. The preperitoneal flap was closed with a running absorbable barbed suture. Conclusions The patient was discharged postoperatively and is doing well on follow-up.