Complex and recurrent hernias can be challenging to treat, particularly in patients who have undergone previous open hernia surgeries. Scar tissue, altered anatomy, and associated medical conditions may require careful surgical planning and advanced laparoscopic techniques.
A recent case managed by Dr. Manas Ranjan Tripathy, Proctologist & Laparoscopic Surgeon, highlights how a minimally invasive approach can be used to manage a complex recurrent inguinal hernia along with an enlarged prostate in an elderly patient.
Patient Profile:
A 95-year-old male presented with persistent right-sided groin swelling, intermittent pain, and urinary frequency for more than a year. He had previously undergone two open hernia repair procedures, both of which had failed.
Diagnosis:
Evaluation revealed a complex recurrent pantaloon inguinal hernia, with both large direct and indirect components. The case also involved preperitoneal fat, a cord lipoma, and dense adhesions resulting from previous surgeries. The patient was also diagnosed with benign prostatic hyperplasia (BPH), contributing to his urinary symptoms.
Considering the complexity of the case, a single-stage approach was planned.
Laparoscopic TAPP Hernia Repair:
A laparoscopic Transabdominal Preperitoneal (TAPP) repair was performed. This posterior approach provided access to the hernia through a different surgical plane, avoiding the heavily scarred anterior tissues from the previous open repairs. The hernia sacs were reduced, the cord lipoma was addressed, and a large 3D mesh was placed to cover the myopectineal orifice.
TURP for BPH:
During the same operative session, Transurethral Resection of the Prostate (TURP) was performed to address the patient’s urinary obstruction. Approximately 25 grams of enlarged prostatic tissue were removed.
The combined procedure was completed under a single anaesthetic. The patient remained haemodynamically stable and experienced a smooth postoperative recovery, with relief from his chronic groin discomfort and improvement in his urinary symptoms.
Conclusion
Complex recurrent hernias require detailed evaluation and an individualized surgical strategy. Advanced laparoscopic techniques such as TAPP repair can provide access to challenging recurrent hernias while avoiding previously operated tissue planes.
This case managed by Dr. Manas Ranjan Tripathy, Proctologist & Laparoscopic Surgeon, demonstrates how carefully planned minimally invasive surgery can address complex abdominal and groin conditions, even in elderly patients.
SARJAPUR ROAD
Manipal Hospital
Survey No. 45/2, Ward 150, Sarjapur–Marathahalli Road, Opposite Iblur, Ambalipura, Bellandur, Bengaluru, Karnataka 560102
📞 +91 8150000200
HSR LAYOUT
#54, 1st Floor, Above SBI Bank, Behind BDA Complex
12th Main Road, HSR Layout, Bengaluru, Karnataka 560102
📞 +91 8150000200
FAQ's
A pantaloon hernia occurs when direct and indirect inguinal hernia sacs are present on the same side of the groin. They develop on either side of the inferior epigastric vessels, giving the appearance of a pair of trousers.
Previous open hernia surgeries can create significant scar tissue in the anterior surgical plane. A posterior laparoscopic TAPP approach allows the surgeon to work through a different anatomical plane, which can be particularly useful when managing recurrent hernias.
In selected patients, hernia repair and prostate surgery may be performed during the same surgical session. The decision depends on the patient’s overall health, surgical risks, and the complexity of both conditions. Careful preoperative assessment and coordination between the surgical teams are essential.
