Gersin K S, Heniford B T, Garcia-Ruiz A, Ponsky J L
Minimally Invasive Surgery Center, Department of General Surgery, Cleveland Clinic Foundation, Department of General Surgery/A80, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Surg Endosc. 1999 Jun;13(6):585-7. doi: 10.1007/s004649901046.
Missed lipoma of the spermatic cord is a pitfall unique to the transabdominal preperitoneal (TAPP) laparoscopic hernia repair. This problem occurs when a palpable inguinal mass is noted preoperatively, but no identifiable hernia defect is found at time of laparoscopy and the procedure is terminated.
Our group encountered six patients without intraperitoneal defects that had large cord lipomas on preperitoneal exploration. Two of these patients had undergone previous intraabdominal laparoscopy for a proposed TAPP repair, which was aborted when no defect was seen.
Both patients were referred for continued symptomatic groin masses, which were subsequently treated by lipoma resection in conjunction with inguinal floor repair.
When patients present with a groin mass, exploration of the preperitoneal space and cord structures is indicated during TAPP repair, even in the presence of a normal-appearing abdominal floor. Abandoning a transabdominal approach without exploration of the preperitoneal structures may lead to a failure to identify symptomatic and/or palpable cord lipomas.
精索脂肪瘤漏诊是经腹腹膜前（TAPP）腹腔镜疝修补术特有的一个陷阱。当术前发现可触及的腹股沟肿块，但在腹腔镜检查时未发现可识别的疝缺损且手术终止时，就会出现这个问题。
我们的团队遇到了6例在腹膜前探查时没有腹腔内缺损但有巨大精索脂肪瘤的患者。其中2例患者此前因拟行TAPP修补术而接受了腹腔内腹腔镜检查，当未发现缺损时手术中止。
这2例患者均因腹股沟肿块持续有症状而前来就诊，随后通过脂肪瘤切除术联合腹股沟盆底修补术进行了治疗。
当患者出现腹股沟肿块时，即使腹壁外观正常，在TAPP修补术中也应探查腹膜前间隙和精索结构。不探查腹膜前结构就放弃经腹入路可能导致无法识别有症状和/或可触及的精索脂肪瘤。
