Joint Inguinal and Femoral Hernia Repair by a Preperitoneal Laparoscopic Approach, Using a Femoral Plug and a Supra-Infrafunicular Mesh Fitted to the Spermatic Cord

摘要

Laparoscopic techniques usually offer good coverage of the rear fascia, by situating the mesh over the spermatic cord, but the lower area, due to pressure from the intestinal mass, is a weak point in this type of repair, especially if the patient also presents a femoral hernia. We have described an enhanced technique with which to repair the femoral hernia and strengthen the lower periligamentary area, based on a preperitoneal laparoscopic approach to access the inguinal area. The laparoscopic repair of inguinal hernia to cover the area of periligamentary weakness poses a major challenge to surgeons. One of the main benefits of the laparoscopic approach is the ability to visualize all hernia orifices in the groin area bilaterally.1 Laparoscopic techniques usually offer good coverage of the rear fascia, by situating the mesh over the spermatic cord,2 but the lower area, due to pressure from the intestinal mass, is a weak point in this type of repair, especially if the patient also presents a femoral hernia. In this situation, we believe that the conventional technique may be inadequate. Accordingly, we have described an enhanced technique with which to repair the femoral hernia and strengthen the lower periligamentary area, based on a preperitoneal laparoscopic approach to access the inguinal area.