Mesh-Preserving Repeat Transabdominal Preperitoneal (Re-TAPP) Repair for Recurrent Direct Inguinal Hernia: A Case Report

Recurrent inguinal hernia after posterior mesh repair is generally managed through an anterior approach to avoid re-entering a previously operated preperitoneal plane.We report an unanticipated repeat transabdominal preperitoneal (re-TAPP) repair in a 76-year-old man with a symptomatic recurrent right direct inguinal hernia and end-stage kidney disease requiring hemodialysis.The patient reported a previous bilateral open repair, prompting the selection of laparoscopy.Intraoperatively, a prior prosthesis and a peritoneal scar indicating a previous posterior repair were identified; the previous operating surgeon subsequently confirmed that the earlier inguinal repair had been TAPP.The recurrent defect appeared to lie beyond the effective coverage of the original mesh, suggesting, but not proving, insufficient prior mesh coverage as a possible mechanism of recurrence.A new peritoneal flap was developed above the prior scar, and the incorporated old prosthesis was preserved to avoid compromising peritoneal coverage.Safe preperitoneal dissection was feasible, allowing the team to continue laparoscopically after considering an anterior approach.The medial, central, and lateral preperitoneal dissection zones were developed, followed by inversion and sutured approximation of tissue consistent with a redundant transversalis fascia pseudosac.A new mesh, adapted inferiorly to accommodate cord structures, with the cut edges separately secured, was placed, and the prosthesis-bearing peritoneal flap was closed over it.Surgery was completed without a reported intraoperative complication.At one month, the patient had satisfactory wound healing, no clinical recurrence or seroma, and no groin pain, although intermittent right inguinal tingling that began several days after surgery persisted.The case illustrates the interaction between preoperative approach selection and intraoperative decision-making when clinical history and surgical anatomy are discordant.Because this is a single case with only one-month follow-up, these findings describe short-term outcomes only; longterm repair durability and the risk of re-recurrence remain unestablished.