Totally Extraperitoneal Inguinal Hernia Repair in a Patient With Cerebral Palsy

Aim Cerebral Palsy (CP) is a group of neurological disorders that affect movement, muscle tone and coordination with the appearance of muscle stiffness, weakness and involuntary movements. Although there is no direct correlation with inguinal hernia, people with CP may be at greater risk of developing hernias due to factors such as chronic constipation, frequent coughing, or physical stress. We present a video highlighting all the difficulties faced in this minimally invasive approach. Material and Methods A 66-year-old woman with CP, without mental but with many mobility problems, presented in outpatient clinic with right groin discomfort. On clinical examination, the inguinal hernia was difficult to identify, but it was confirmed by an ultrasound scan. The patient requested a laparoscopic approach hoping for faster recovery and less hospital stay. After placing the patient on the operating table with special supports and the left leg flexed, through an incision in the right upper quadrant of the abdomen, the endoscope was inserted with a visiport of 10 mm in the retrorectus space. Preperitoneal space was dissected with CO2 and with the use of a 0 degree endoscope. Two additional 5 mm ports were inserted in the lower midline. The pubic symphysis and inferior epigastric vessels, due to their location and distorted anatomy in this area, were very difficult to identify initially. The hernia sac was identified and reduced. A mesh of 15 × 10 cm was placed in the preperitoneal area without fixation. Results The patient's postoperative course was smooth, but her discharge was delayed due to the need for extensive physiotherapy. At follow-up at 12 weeks, patient was well and free of symptoms from the groin area. Conclusion Laparoscopic inguinal hernia repair with the TEP technique in cases of patients with stiffness or movement disorders has several difficulties and requires advanced laparoscopic skills. Careful patient selection and accurate consent of the patient mentioning the increased likelihood of conversion to an open method are essential.