Wang Congfei, Lin Ronggui, Lin Xianchao, Lu Fengchun, Chen Yanchang, Huang Heguang
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
J Minim Access Surg. 2022 Oct-Dec;18(4):629-631. doi: 10.4103/jmas.jmas_283_21.
The Kugel procedure resulted in extensive adhesion in the preperitoneal space. Performing a transabdominal preperitoneal repair (TAPP) for recurrent hernia after Kugel procedure is extremely difficult. In this case report, we present the case of a 81-year-old male who presented with recurrent inguinal hernia after Kugel procedure 8 years ago. Transabdominal laparoscopy was performed first. Indirect hernia formed inferior to the lateral edge of the previous mesh was diagnosed under laparoscopy. The patient's medial umbilical ligament (MUL) was big enough and could be completely released by separating the Retzius space. Finally, TAPP was successfully performed by using the MUL to create and close the preperitoneal space. No perioperative complications or hernia recurrence was observed 1 year after the surgery. Using the MUL to deal with preperitoneal problems was practical and feasible.
库格尔手术导致腹膜前间隙广泛粘连。在库格尔手术后进行经腹腹膜前修补术（TAPP）治疗复发性疝极其困难。在本病例报告中，我们呈现了一名81岁男性的病例，该患者在8年前接受库格尔手术后出现复发性腹股沟疝。首先进行了经腹腹腔镜检查。在腹腔镜下诊断出在先前补片外侧边缘下方形成的间接疝。患者的脐内侧韧带（MUL）足够大，通过分离雷氏间隙可将其完全松解。最后，利用MUL创建并封闭腹膜前间隙，成功实施了TAPP。术后1年未观察到围手术期并发症或疝复发。利用MUL处理腹膜前问题切实可行。
