P132 TRANSABDOMINAL PREPERITONEAL REPAIR (TAPP) FOR DE NOVO TYPE INGUINAL HERNIAS

Aim In Japan, the de novo type inguinal hernia is defined as a hernia that develops without being related to the vaginal process of peritoneum. The pathological condition of a de novo type hernia is considered similar to that of a sliding hernia. the aim of this study is to discuss about the operative procedure for de novo type inguinal hernia, with a particular focus on lipomas. Material and Methods We examined surgical procedures, rate of combined lipoma, postoperative complications, and recurrence rates of de novo cases among TAPP cases performed in our department from 2018 to 2020. Results We performed 230 TAPP repairs during the period, included 56 de novo type hernia. 19 cord lipomas were found in de novo type hernias but none in non de novo type hernias. The lipomas prolapsed from the lateral side of the internal inguinal ring in 6 cases, medial side in 9 cases, In 4 cases, lipoma or lipomatous tissue were embedded in the spermatic cord and they could not be extracted. There were no postoperative complications. The average postoperative hospital stay was 1.2 days. There were no chronic pain nor recurrence. Conclusions It is important to note that the de novo hernia is associated with a high incidence of lipoma. Since lipomas are often attached to the peritoneum, dissecting the peritoneum at the internal inguinal ring has the risk of missing the presence of lipomas, and in de novo hernias, the peritoneum must be pulled out.

Acquired cryptorchidism: an unexpected consequence of inguinoscrotal lymphatic malformation treated with Eppikajutsuto

Lymphatic malformation (LM) that causes inguinoscrotal swelling is extremely rare. Surgery, sclerotherapy and pharmacotherapy have been reported as possible treatment options for LM. Recently, Eppikajutsuto (TJ-28), a traditional Japanese herbal medicine has emerged as therapeutic option for LM. We report the case of a 2-year-old boy who presented with a left inguinoscrotal swelling, which was diagnosed as retroperitoneal LM extending into the left scrotum. The surgical approach was less favourable, given the risk of damaging the testicular vasculature or the spermatic cord. Therefore, the patient received medical treatment with TJ-28. As a result, a volume reduction of 83% was obtained, as well as the unexpected consequence of the left testicle retracting into the inguinal area. Laparoscopic exploration was performed and a small bulge on the internal inguinal ring was detected. The patient’s acquired cryptorchidism was subsequently treated by orchidopexy.

Incarcerated Appendix Epiploica in Inguinal Hernia Sac: Treatment with Laparoscopic TAPP Approach—Report of a Rare Case

Appendix epiploica (AE) in an incarcerated inguinal hernia sac is very rare. We herein report the case of a 57-year-old man admitted to the emergency department with complaints of nausea, swelling, and pain in the left inguinal area. He was diagnosed with left incarcerated inguinal hernia and treated laparoscopically with transabdominal preperitoneal (TAPP) mesh hernioplasty. During the operation, AE, lodged in the direct hernia sac, was seen to originate from the sigmoid colon. The narrow internal inguinal ring was incised at the 2 o’clock position using a monopolar hook, and the hypertrophic AE was reduced to the abdomen and resected. The patient was discharged uneventfully on the second postoperative day.

Toward sutureless laparoscopic inguinal hernia repair in children?

We report our experience with a sutureless technique for laparoscopic inguinal hernia repair in children. Twenty-eight children, 12 girls and 16 boys, aged 3 months to 7 years, underwent sutureless laparoscopic inguinal hernia repair. In girls, we utilized simple cauterization of the internal inguinal ring with a single trocar technique. In boys denudation of the peritoneum was obtained utilizing a three-trocar technique. The peritoneum around the internal inguinal ring was peeled off and detached from the vas and the vessels, and then wrapped around the grasper, resulting in a large area of denudation. No perioperative complications were observed. No recurrences nor testicular damage were noted after a mean follow-up of 18 months (range 6-35 months). The mean operative time was 12 min (range 7-20 min) for girls and 19 min (range 15-30 min) for boys. A 6-year-old girl exhibited a lymphocele. The sutureless technique appears to be easy, safe, and effective, provided that the patients are carefully selected. In boys, special attention needs to be paid to preservation of the vas and the testicular vessels.

Testicular–Epididymal Dissociation: Vas and Vessels May “Lead up the Garden Path”

The vas deferens and spermatic vessels entering the inguinal canal through the internal inguinal ring is thought to exclude an intra-abdominal testis. We present a case of high bilateral intra-abdominal testes on a 46,XY boy despite the vas deferens and good-sized vessels passing through the deep rings.Data were collected from clinical records, radiology (ultrasound, magnetic resonance imaging [MRI]), and endocrine blood tests.This case underlines the importance of following the pathway of embryological descent of the testis cranially as well as caudally during diagnostic laparoscopy, to avoid missing this rare anatomical variant.

The Role of the Appendix Testis in Normal Testicular Descent: Is There a Connection?

Objective. The presence of testicular appendices was prospectively evaluated in 89 boys with 96 undescended testes who underwent orchidopexy over the period of 4 years.Results. The patients were divided into two groups. Group A included 42 boys with 49 undescended testes positioned close to the internal inguinal ring, and Group B included 47 boys with 47 undescended testes close to the external inguinal ring. The incidence of appendix testis (AT) in Group A was 57.1% (28 in 49) and 78.7% (37 in 47) in Group B. The results of our study showed significantly decreased incidence of testicular appendices in undescended testes positioned close to the internal inguinal ring compared with undescended testes positioned close to the external inguinal ring (p<0.05).Conclusion. AT may play a role in normal testicular descent and the undescended testis positioned close to the external inguinal ring can be considered as a separate entity of the true congenital undescended testis.