Fascia lata transabdominal pre-peritoneal repair in incarcerated inguinal hernia (FL TAPP) - A case report.

INTRODUCTION AND IMPORTANCE

Fascia Lata is one of the oldest materials used in the repair of inguinal hernia. It lost its popularity following the advent of meshes, mainly Tantalum and Marlex. However, the use of synthetic meshes in infected scenario is controversial. Biological meshes though started off as a potential reinforcement in contaminated fields did not show much benefit. In our case, we describe a successful technique where fascia lata was harvested and laparoscopically placed as a free graft in the preperitoneal plane for inguinal hernia repair.

CASE PRESENTATION

A 58-year-old man presented with right inguinal hernia associated with pain of two days duration and vomiting. On ultrasound, he had acute cholecystitis and incarcerated omentum in the right inguinal region. Patient underwent a Trans-Abdominal Pre-Peritoneal (TAPP) laparoscopic repair of the inguinal hernia.

CLINICAL DISCUSSION

Synthetic meshes have been associated with complications such as mesh erosion, migration and chronic inguinodynia which is often difficult to treat. The deployment of mesh in contaminated fields is even more controversial as infection of the mesh always needs to be explanted or can lead to chronic sinus formation. Fascia lata, on the other hand can withstand infection better compared to synthetic meshes as it is biological and an autologous material.

CONCLUSION

To our knowledge, it is the first described use of Fascia Lata in the pre-peritoneal space for Laparoscopic Inguinal Hernia repair. There have been reports of the use of Fascia Lata in Incisional hernias by a Japanese group. We describe the technique with favorable outcomes.