Laparoscopic Mesh Research Articles

A03 - BN Long Term Quality of Life Outcomes Following the Surgical Management of Complete Intrathoracic Stomach (CIS)

Abstract Background Surgery is indicated for symptomatic patients with complete intrathoracic stomach (CIS) to avoid complications (volvulus, obstruction and strangulation) associated with high morbidity. There remains limited evidence of the long-term outcomes and improvement in symptoms from this procedure. Previous large studies have been unable to compare pre-operative symptoms with their post-operative data. Although it appears the procedure has favourable outcomes, further data is required to demonstrate a significant improvement in quality of life (QoL). We therefore aim to assess the long-term outcomes, including changes to QoL and satisfaction, for patients who underwent laparoscopic biological hiatal mesh reconstruction for CIS (100%). Method Prospective data was collected from 154 consecutive GPEH (Giant Hiatus Hernia) patients intervened between March 2008- December 2023 in a large DGH. Retrospective analysis of this identified a subgroup of 34 patients with CIS. All patients underwent a laparoscopic repair with biological mesh, apart from one patient who underwent gastropexy. Outcome measures included both pre-operative and post-operative standardised GERD-Health Related Quality of Life Questionnaire (GERD-QOL) scores; complications; and patient satisfaction. Results Thirty-four patients were included (11 male:23 female) with a mean age 72 (45-83) years. All patients were symptomatic pre-operatively with heartburn (59%), dysphagia (59%), retrosternal discomfort (53%), vomiting (41%), weight loss (41%) or shortness of breath (35%). There were 4 (12%) complications and 3 (9%) 30-day mortalities. Follow up GERD-QOL questionnaires displayed 32/34 (94%) excellent scores (defined as total <5) at 6 months and 15/21 (71%) excellent scores after a median follow up of 8.5 years (72% response rate, 2 further mortalities). This demonstrated a significant improvement in scores following the procedure and long term (p<0.001). Nineteen patients (90%) were satisfied with the procedure after long term follow up (median 8.5 years). Conclusion Laparoscopic repair of complete intrathoracic stomach in this large single-centre study has demonstrated a significant improvement in symptoms and satisfaction over a median 8.5 year follow-up.

Inguinal hernia recurrence after laparoscopic mesh removal for chronic pain: a single-center experience with 11years of practice.

Up to 12% of patients undergoing minimally invasive inguinal hernia repair may develop chronic postoperative inguinal pain (CPIP), possibly explained by the presence of mesh. Recent studies reported that laparoscopic mesh removal is feasible and safe. However, the risk of a hernia recurrence is unknown. This observational study describes the rate of hernia recurrence and evolution in pain score following laparoscopic mesh removal for CPIP after preperitoneal inguinal hernia repair. Prospectively collected questionnaires and operative notes of consecutive patients undergoing a laparoscopic mesh removal for CPIP in our center of expertise between November 2011 and July 2022 were studied. Pain scores were quantified using the Numeric Pain Rating Scale (NRS, 0-10). The presence of a hernia recurrence was based on patient history and clinical findings. A total of 89 patients underwent laparoscopic mesh removal, and data of 83 patients (93% response rate) were available for analysis. Median decrease in pain score (NRS) after mesh removal was 4 (range + 2 to -9). After a median 4.3years follow up period, a hernia recurrence was present in 18 patients (21.7%). Of these, eight were symptomatic requiring correction using a Lichtenstein repair with a favorable outcome whereas a wait-and-see approach was successfully followed in the remaining 10 patients. Laparoscopic mesh removal for CPIP following preperitoneal inguinal hernia repair resulted in an inguinal hernia recurrence in one of five patients requiring remedial surgery in one in ten patients. This knowledge may inform the preoperative counseling process.

Mesh-associated complications in minimally invasive ventral mesh rectopexy: a systematic review.

Ventral mesh rectopexy (laparoscopic and robotic) is a common and well established treatment of rectal prolapse. Although described as safe and effective, complications, especially mesh-associated ones are often mentioned. Additionally, there is no consensus regarding the mesh type and fixation method as well as the materials used for this purpose. The aim of this systematic review was to identify the total amount of complications and of those the mesh-associated ones. Pubmed, Web of Science and Cochrane Central Register were screened for complications in general and in detail regarding the mesh(es) and a systematic review was performed. Following qualitative evaluation, 40 studies were identified for further investigation. Across 6269 patients, complications were found in 9.2% (622 patients). Mesh-related complications were described in 1.4% (88 patients) of which 64.8% were erosions, 11.4% fistulas and 13.6% mesh releases. The complication rate according to the different materials were low with 1% in biological and synthetic meshes and 1.8% in not further described or mixed mesh type. Non-absorbable material to fixate the mesh was most frequently used to fixate the mesh. Laparoscopic ventral mesh rectopexy is a safe operation with a low-complication rate, regardless of mesh type.

Combined Laparoscopic and Vaginal Radical Prolift Mesh Excision With Left Sacral Nerve Root Detrapment

Combined Laparoscopic and Vaginal Radical Prolift Mesh Excision With Left Sacral Nerve Root Detrapment

Enhanced view totally extraperitoneal approach: The best available option for recurrent incisional hernias following previous laparoscopic intraperitoneal onlay mesh plus repairs.

The available options for recurrent incisional hernias (RIH) following previous laparoscopic intraperitoneal onlay mesh (IPOM) plus were open onlay repair, open Rives-Stoppa (RS), laparoscopic enhanced view totally extraperitoneal-RS (ETEP-RS) and laparoscopic subcutaneous onlay mesh repair. Majority of these RIH were managed by open onlay mesh repairs or laparoscopic Redo IPOM plus. There are not much data available in the literature on the ETEP approach for RIH following previous IPOM plus with the placement of mesh in the retrorectus space. In this article, I would like to share technical aspects, challenges faced and tips to overcome these challenges of performing ETEP for RIH following previous IPOM plus repairs.

Epigastric Ventral Hernia Repair Through Vaginal Natural Orifice Transluminal Endoscopic Surgery.

Ventral hernia repair is a commonly performed operation and can be executed by open or laparoscopic approach. The search for even less invasive techniques continues. Natural orifice transluminal endoscopic surgery (NOTES) is a known method of minimally invasive surgery. We performed an epigastric ventral hernia repair through vaginal NOTES during a concurrent hysterectomy and bilateral salpingectomy. We used the access to do a synchronous hernia repair with mesh augmentation. The technique of repair was identical to the laparoscopic intraperitoneal onlay mesh repair (Lap. IPOM). We reported a sufficient hernia repair without intra-operative complications. Also, post-operatively, no problems were encountered. Follow-up after 4 weeks showed a good and strong hernia repair. The complaints of the patient were relieved. CT scan 10 months after operation showed no recurrence nor signs of mesh infection. Ventral hernia repair through vaginal NOTES can be considered a possible new and minimal invasive (scarless) technique for ventral hernia repair but further investigations on a larger scale are needed to confirm feasibility & safety.

166 - Impact of age and body mass index on the outcomes of laparoscopic mesh sacrocolpopexy

166 - Impact of age and body mass index on the outcomes of laparoscopic mesh sacrocolpopexy

Anatomical and functional outcomes of rectal prolapse treatment with laparoscopic pelvic organ prolapse suspension versus laparoscopic ventral mesh rectopexy

AbstractAimVery few studies have compared laparoscopic pelvic organ prolapse suspension (POPS) and laparoscopic ventral mesh rectopexy (LVMR) in the treatment of rectal prolapse, particularly regarding the comparison of improvement rates in obstructed defecation syndrome (ODS). This study aimed to compare the anatomical and functional outcomes of these two methods over a long‐term follow‐up period.Patients and methodsThis retrospective study was conducted on 120 female patients diagnosed with rectal prolapse who underwent surgery at the Colorectal Surgery Department of Shahid Faqihi Hospital in Shiraz, Iran, between October 2015 and October 2022. The patients were categorised into two groups based on their surgical procedures: 58 underwent LVMR in the first group, and 62 underwent POPS in the second group.ResultsRecurrence of prolapse occurred in 7 (12.1%) patients in the LVMR group and 5 (8.1%) patients in the POPS group (P = .550). The mean operation time, mean length of hospital stay, Visual Analogue Scale score, early and late post‐operative complications, Cleveland Clinic Incontinence Score, ODS symptoms, and Wexner Constipation Scores did not differ significantly between the two groups.ConclusionBoth laparoscopic POPS and LVMR techniques significantly improved the anatomical and functional outcomes in the treatment of rectal prolapse and obstructed defecation. LVMR and POPS can each be considered first‐line treatment options for rectal prolapse, depending on the specific case.

Iatrogenic small bowel perforation during elective laparoscopic intraperitoneal onlay meshplasty leading to intraoperative change of plan: a case report with review of literature

Iatrogenic bowel injury during any surgery, be it open or laparoscopic; is associated with significant morbidity. Moreover, if the said injury occurs in a surgery in which a foreign material is planned to be implanted in the patient’s body as a prosthesis e.g., hernia surgery; the surgical team may have to deviate from its original plan of action. Even in the best of hands, iatrogenic bowel trauma can occur inspite of following best recommended practices. This usually occurs in the setting of dense adhesions of bowel to the parietes. Herein, we present one such case of a 72-year-old lady who was planned for laparoscopic incisional mesh hernioplasty, but had to be subjected to an intraoperative change in plan, due to iatrogenic enterotomy.

ThP3.6 - Long Term Surgical Outcome of Complete Intrathoracic Stomach (CIS)

Abstract Background & Aims Surgery is required for medically fit symptomatic CIS patients to avoid complications (volvulus, obstruction & strangulation) that have high morbidity & mortality. To assess the long term outcome including QOL (quality of life) for patients who underwent laparoscopic biological hiatal mesh reconstruction for CIS (100%). Methods Retrospective analysis of a prospectively collected of 34 CIS of 154 consecutive GPEH(Giant Para-Esophageal Hernia) patients intervened between March 2008- December 2023 in a large DGH. Data collected included demographics, BMI, ASA, Preoperative investigations (OGD & Computerised Tomography), operative details including complications, & standardised GERD-Health Related Quality of Life Questionnaire(GERD-QOL) scores of 0-5, 6-10, 11-15 & more than 15 as excellent, good, fair & poor respectively (pre-operatively, 6-month post-operative & long-term), postoperative diet, SOB (shortness of breath) & patient satisfaction. Results 34 included M:F 11: 23, age 72*(45-83) years, BMI 29 *(20-43), ASA III *(II-III). 20(59%), 20(59%), 18(53%), 14(41%), 14(41%) & 12(35%) had heartburn, dysphagia, retrosternal discomfort, vomiting, weight loss and SOB respectively. 6 (18%) emergencies, 22 (65%) incomplete OGDs, operative time 210* (150-510) mins, 1(3%) conversion, 3*(9%) surgical mortality & PO stay 3*(2-27) days. Pre and 6-month post surgery GERD-QOL poor (≥15) & excellent (<5) in 21(62%) & 32(94%) respectively with 32(94%) excellent satisfaction. Follow up at 102*(16-190) months had 2 more unrelated deaths, 21(72%) contacted with GERD-QOL excellent (<5) in 14(67%), poor 1(5%), 19(90%) solid diet, 2(10%) SOB with 19(90%) excellent satisfaction. Conclusion Favourable long term outcome achieved here supports complex surgery for this debilitating condition in the medically fit symptomatic elderly patients. * Median

Reduced port laparoscopic rectopexy for full-thickness rectal prolapse

BackgroundLaparoscopic rectopexy is an established treatment option for full-thickness rectal prolapse. Recently, reduced port surgery (RPS) has emerged as a novel concept, offering reduced postoperative pain and improved cosmetic outcomes compared with conventional multiport surgery (MPS). This study aimed to evaluate the feasibility and safety of RPS for full-thickness rectal prolapse.MethodsFrom October 2012 to December 2018, 37 patients (MPS: 10 cases, RPS: 27 cases) underwent laparoscopic rectopexy for full-thickness rectal prolapse. Laparoscopic posterior mesh rectopexy (Wells procedure) is the standard technique for full-thickness rectal prolapse at our hospital. RPS was performed using a multi-channel access device, with an additional 12-mm right-hand port. Short-term outcomes were retrospectively compared between MPS and RPS.ResultsNo significant differences were observed between MPS and RPS in the median operative time, the median blood loss volume, the postoperative complication rates, and median hospital stay duration after surgery.ConclusionReduced port laparoscopic posterior mesh rectopexy may serve as an effective therapeutic option for full-thickness rectal prolapse. However, to establish the superiority of RPS over MPS, a prospective, randomized, controlled trial is warranted.

613. LAPAROSCOPIC MANAGEMENT OF TYPE IV HIATAL HERNIA WITH MESH AUGMENTATION CRUROPLASTY - EXPERIENCE AT A TERTIARY CARE CENTRE

Abstract Background Type IV para-esophageal hernias, which are characterized by herniation of other organs in addition to stomach, are rare - comprising only 2-5% of all para-esophageal hernias. They are associated with life-threatening complications such as strangulation or perforation of stomach. Laparoscopic treatment of these hernias requires excellent advanced laparoscopic suturing and dissecting skills. Although laparoscopic approach is now universally accepted, the role of mesh augmentation remains debated. Methods Case records of patients who underwent Laparoscopic mesh augmentation cruroplasty for Type IV hiatal hernia since 2012 were retrospectively analyzed. Results Out of 340 patients who underwent hiatal hernia repair, 7 patients (3males, 4females) fulfilled the selection criteria. Median age was 64(53-89) years. Median duration of symptoms was 2months (15days-6months). All patients complained of heartburn. Vomiting was present in 5(71%) patients; only 1(14%) patient had persistent vomiting with dysphagia. Respiratory symptoms were present in 2(29%) patients. No patient had features of peritonitis or sepsis. One patient had undergone laparoscopic heller’s cardiomyotomy twice before. All patients underwent MDCT which confirmed type IV paraesophageal hernia. Median operating time was 150(100-280) minutes. Median blood loss was 150(50-400) ml. 6(85%) patients had herniation of omentum in addition to stomach while 1 patient had herniation of omentum and transverse colon. No patient had ischemia/perforation of stomach. Median hiatal defect was 6(5-8) cm. Sac was excised completely in all cases following reduction of contents. Crural repair was done with1-0 polyester interrupted sutures. In some patients, anterior cruciate ligament repair was done to avoid tenting of esophagus. Rectangle shaped Composite mesh with key-hole slit in upper border was placed. Mesh was anchored with interrupted 1-0ethilon sutures. Fundoplication (Nissen’s/Toupet) was done in all patients, none required esophageal lengthening procedure. Median post-operative stay was 5(2-8) days, median ICU stay was 1(0-4) days. Oral liquids were started on 2 nd (1-3) post-op day and solids on 4 th (2-5) day. 2(29%) patients had post- operative complications - atrial fibrillation and transient respiratory failure respectively. Median follow-up was 14(1-40) months. No patient had symptomatic recurrence. OGDscopy at 6months was normal in 5 patients. No mesh related complication was observed. Discussion Wide hiatal defects were noted in all patients. This necessitated mesh augmentation of crural repair. Both short-term (morbidity, mortality) and long-term outcomes (recurrence, patient satisfaction) were excellent.

Transabdominal levatorplasty technique in laparoscopic mesh rectopexy for rectal prolapse.

Rectal prolapse is characterized by a full-thickness intussusception of the rectal wall and is associated with a spectrum of coexisting anatomic abnormalities. We developed the transabdominal levatorplasty technique for laparoscopic rectopexy, inspired by Altemeier's procedure. In this method, following posterior mesorectum dissection, we expose the levator ani muscle just behind the anorectal junction. Horizontal sutures, using nonabsorbable material, are applied to close levator diastasis associated with rectal prolapse. The aim of the transabdominal levatorplasty is to (i) reinforce the pelvic floor, (ii) narrow the anorectal hiatus, and (iii) reconstruct the anorectal angle. We report a novel transabdominal levatorplasty technique during laparoscopic rectopexy for rectal prolapse. The laparoscopic mesh rectopexy with levatorplasty technique was performed in eight cases: six underwent unilateral Orr-Loygue procedure, one modified Wells procedure, and one unilateral Orr-Loygue procedure combined with sacrocolpopexy for uterine prolapse. The median follow-up period was 178 (33-368) days, with no observed recurrences. Six out of seven patients with fecal incontinence experienced symptomatic improvement. Although the sample size is small and the follow-up period is short, this technique has the potential to reduce the recurrence rate and improve functional outcomes, as with levatorplasty of Altemeier's procedure. We believe that this technique may have the potential to become an option for rectal prolapse surgery.

A retrospective study of predisposing factors and management of incisional hernia in a tertiary care hospital

Background: An incisional hernia is characterized as any defect in the abdominal wall, with or without a noticeable bulge, in the region of a postoperative scar, identifiable through clinical examination or imaging. This condition can be detected through clinical examination or imaging and affects approximately 10-20% of patients who undergo abdominal operations. Aims and objectives of the study was to evaluate various precipitating factors, clinical presentations, management and post-operative complications in patients with incisional hernia. Methods: A retrospective study of 150 patients conducted at a tertiary care teaching hospital. Results: In this study, incisional hernia was more common in obese, elderly, and female patients. The incidence was higher with Pfannenstiel incision followed by lower midline incisions. Incisional hernia was common between 1-5 years of index surgery and it was observed that more the risk factors and complications associated with index surgery, earlier was the onset of incisional hernia. Patients had a defect of size <4x4 cm were 58.66%. Open onlay mesh repair was done in 36.66% patients, preperitoneal mesh repair in 13.33%, retro rectus mesh repair in 13.33%, laparoscopic mesh repair in 28.66% and anatomical repair alone in 7.99% patients. Duration of laparoscopic surgery was longer compared to open. Most common post- operative complication was seroma (4.66%) followed by wound infection (2.66%). Conclusions: Incisional hernias occur more in females as they commonly undergo lower abdominal surgeries. Subcutaneous suction drain decreased the incidence of post-operative wound complications.

A comparative study on effects of defect closure versus non-closure in laparoscopic totally extraperitoneal repair of direct inguinal hernia.

Totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair are the principal techniques in laparoscopic hernia repair. Seroma formation and pain are frequent complications of moderate-large size laparoscopic direct inguinal hernia mesh repair. This study was conducted to evaluate the feasibility of defect closure in moderate-large direct inguinal hernias and its effect on various outcomes. This is a prospective cohort study from September 2020 to August 2021, where a total of 88 patients with uncomplicated direct inguinal hernia (M3 or more) were enrolled in the study and divided into two equal groups of TEP defect closure and non-closure, and various outcome measures were noted. The majority of patients were male (94.31%), with a mean age range of 18-85 years, and had right-sided inguinal hernia (46.5%). Seroma formation at 10th POD in the defect closure and non-closure were 24% and 33% (p value: 0.225), which reduced to 11% and 18%, respectively, at 1 month (p value: 1.000). All seromas resolved within 6 months. Pain in VAS at 10th POD in the defect closure and non-closure were 1.55±0.571 and 1.38±0.527, respectively (p value: 0.121), which gradually decreased to 1.20±0.524 and 1.16±0.420 at a 6-month interval (p value: 0.689). The mean operative time in the bilateral and unilateral defect closure groups was 72.3±4.1 and 56.5±4.3 min, respectively, whereas that in the bilateral and unilateral defect non-closure groups was 62.3±3.7 and 45.7±3.6 min, respectively. The defect closure was found to have higher pain and less seroma formation at various intervals of time following TEP for moderate-large direct inguinal hernia. Although these findings were statistically insignificant, they may be clinically significant, and further studies with a larger sample size are suggested.

Initial experience of minimally invasive mesh explantation for inguinodynia.

Chronic pain after minimally invasive inguinal hernia repair with mesh can have debilitating effects on quality of life (QOL), limiting daily activities and ability to work. Many medical and surgical options for treatment have been proposed, however there is no consensus on the role of mesh explantation in the management of these patients. We performed a retrospective review of all patients who underwent groin mesh removal by robotic or laparoscopic approach from July 2012 to July 2023 at our institution. Patients were interviewed post-operatively to determine their overall pain scores and QOL was assessed using the Carolinas Comfort Scale (CCS) Questionnaire. Patient characteristics, operative times, pre-operative imaging techniques and analgesia use was also recorded. Twenty-two patients underwent groin mesh removal for chronic pain, including 12 robotic and 10 laparoscopic operations. The mean pre-operative pain score in all patients was 7.6/10 compared to 4.0/10 post-operatively. The mean post-operative CCS score was 24, indicating moderate discomfort. Four patients demonstrated CCS scores <11 indicating no discomfort and no patients demonstrated CCS scores >90, indicating severe debilitating discomfort. The majority of patients had a reduction or total cessation of analgesia intake post-operatively. Both laparoscopic and robotic mesh explantation for treatment of chronic pain post-inguinal hernia repair is safe and effective in achieving a reduction in pain and reducing the need for long-term analgesia.

Hybrid intraperitoneal onlay mesh repair for incisional hernias: a systematic review and meta-analysis.

Laparoscopic IPOM is technically challenging, especially regarding fascial closure. Hybrid repair has been proposed as a simpler approach. We aimed to compare hybrid and laparoscopic intraperitoneal onlay mesh repair (IPOM) in patients undergoing ventral hernia repair (VHR). We performed a systematic review of Cochrane, Scopus, and MEDLINE databases to identify studies comparing hybrid versus laparoscopic IPOM VHR reporting the outcomes of recurrence, mortality, seroma, postoperative complications, reoperation, surgical site infection, and operative time. Statistical analysis was performed using RStudio 4.1.2 using a random-effects model. We screened 2,896 articles and fully reviewed 22 of them. A total of five studies, encompassing 664 patients were included. Among them, 337 (50.8%) underwent laparoscopic IPOM. All patients had incisional hernias, with a mean diameter varying from 3 to 12.7cm, 60% were women, with a mean BMI varying from 29.5 to 38. The hybrid approach had a lower rate of seroma when compared to the laparoscopic (OR 0.22; 95% CI 0.05 to 0.92; p = 0.038; I²=78%). We found no difference in recurrence, mortality, postoperative complications, reoperation, surgical site infection, and operative time between groups. Hybrid IPOM is a safe and effective method for incisional hernia repair. Moreover, it facilitates fascial defect closure and decreases postoperative seromas.

Comparison of Surgical Outcomes of Laparoscopic Ventral Mesh Rectopexy and Stapled Transanal Rectal Resection for Managing Obstructed Defecation Syndrome

Abstract Background: Obstructed defecation syndrome has several underlying causes and is a prevalent but poorly understood condition. It is characterized by the inability to pass stool even when one experiences the urge to defecate. Initial therapy for ODS usually involves diet modifications, pelvic floor exercises, and biofeedback, which can considerably reduce symptoms. Surgical intervention may be recommended for individuals who present with certain anatomical anomalies and who do not respond to conservative therapies. Objectives: To assess and compare the surgical outcomes of laparoscopic ventral mesh rectopexy (LVMR) and stapled transanal rectal resection (STARR) for ODS management. Design: The study conducted a retrospective review of prospectively gathered data on the outcomes of 162 patients treated for ODS at our facility between January 2015 and January 2022 using either LVMR or STARR. Settings: The study was conducted at our facility between January 2015 and January 2022, evaluating 162 patients with ODS who underwent either LVMR (118 patients) or STARR (44 patients). Patient and Methods: The Modified Longo’s Scores (MLS) were used as the primary evaluation tool, determined preoperatively and postoperatively at 1 month, 6 months, and 12 months. Sample Size: A total of 162 patients were included in the study, with 118 patients who underwent LVMR and 44 patients who underwent STARR for the treatment of ODS at our facility between January 2015 and January 2022. Results: Preoperative MLS for LVMR patients averaged 23.41, which was similar to that of STARR patients (23.52), showing no statistically significant difference. After 1 month, the mean MLS showed a significant decrease of 93.3% among LVMR patients and that of 18.0% among STARR patients from the preoperative mean MLS, indicating a significantly greater change among LVMR patients than among STARR patients. Similarly, after 6 months, the preoperative mean MLS for LVMR patients and STARR patients revealed a substantial decline of 95.4% and 6.5%, respectively, with LVMR patients experiencing a considerably greater change than STARR patients. After 12 months, the mean MLS showed a significant decrease of 96.6% and 3.6% among LVMR and STARR patients from the preoperative mean MLS, respectively, with change being significantly more among LVMR patients than STARR patients. Conclusion: LVMR can be the preferred method because it outperforms STARR in terms of alleviating ODS symptoms. Limitations: This research involved a retrospective study using a small sample size and a short follow-up period. Conflicts of Interest: None.

Comparison of postoperative outcome of laparoscopic and open inguinal hernia mesh repair

Comparison of postoperative outcome of laparoscopic and open inguinal hernia mesh repair

An unusual case of an isolated, incarcerated appendix epiploica inguinal hernia and laparoscopic mesh herniorrhaphy

Abstract An isolated appendix epiploica (AE) inguinal hernia remains a rare surgical entity despite laparoscopic herniorrhaphy and improved intra peritoneal visualization. The surgical disposition of the AE remains controversial with proponents for both excision and conservative management. The paucity of data, based only on case reports precludes definite guidelines in their management. The presence of infection, organ ischemia, surgeon experience, and biological mesh availability all play a role in the management of this type of hernia. We present a rare case report with a viable incarcerated, AE inguinal hernia and its laparoscopic excision, and hernia repair. This is only the third such case report in the published literature to date.