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Abstract

Background: This is a case report of a four-time recurrent inguinoscrotal hernia on the left side, that was finally successfully operated using robotic daVinci da Xi (Intuitive) intraperitoneal Onlay-Mesh-Plastic (rIPOM) hernia repair technique. To date, robotic IPOM operation procedures are less common in Europe. Therefore, we present our experience with this method for the treatment of a multiple recurrent inguinoscrotal hernia.Case Presentation: This is a single-institute presentation and report of a challenging case. A 77-year-old man with a large four times recurrent inguinoscrotal hernia was treated using a minimally invasive robotic IPOM technique. The previous hernias repairs were performed during a period of 21 years between 1996 and 2015. In 1996, the initial hernia on the left side was an open transversalis plastic (Barwell). After two years, in 1998 the first recurrence occured and was treated with open mesh plastic (Lichtenstein). Six years later, in 2004 the second recurrence occured and was repaired with open preperitoneal mesh plastics (Rivers-Stoppa). Eleven years later, in 2015 the third hernia recurrence with incarceration of the colon was diagnosed. The hybrid operation mediale laparotomy for colon revision without resection and laparoscopic mesh palstic (TAPP) were performed. The current forth recurrence of the inguinoscrotal hernia appeared after four years in 2019. Its diagnosis was based on the patient's history and physical examination. The rIPOM repair was performed and almost four years of follow-up showed that the patient was both recurrence and complications free. Conclusion:The IPOM technique takes less time because intraoperative preparation of the preperitoneal space is not required and because it allows mesh coverage of the entire myopectineal orifice. The robotic approaches, as compared to laparoscopic approaches, provide the opportunity for better three-dimensional visualisation, elimination of surgeon tremors and precise dissection. We suggest the robotic IPOM technique in cases of multi-recurrence inguinoscrotal hernia if other open or minimally invasive hernia surgeries have failed.