Peri-Inguinal Hernias in Laparoscopic era

Abstract

Introduction: Hernias that do not correspond to the usual sites of hernias in the inguinal and femoral region have been described. Laparoscopic vision provides a much broader and clearer perspective that allows visualizing these hernia defects. The purpose of this paper is to report two cases of peri-inguinal hernias solved by laparoscopy, and to review this unknown situation by many surgeons today. Methods: A search of the terms “peri-inguinal hernia”, “periinguinal hernia”, “para-inguinal hernia”, and parainguinal hernia” was performed in the databases PubMed, SciELO and Medline; supplemented by means of the search engine Google, Yahoo and Wikipedia, searching also reference lists of similar cases and review articles. Conclusion: Peri-inguinal hernias are a very rare type of hernias. These hernias are a reality that must be recognized, and laparoscopy is a very useful method to diagnose and treat them.

Para-inguinal hernia; presentation, diagnosis and surgical treatment, a case report

“…Gallese (1991) differentiated between para-inguinal and peri-inguinal hernias by involvement of the internal ring, whereby para-inguinal hernias penetrate into the canal and peri-inguinal hernias do not [ 9 ]. This terminology has not been adopted and has been suggested to increase confusion [ 10 ]. While the majority of cases in the literature do not involve the inguinal canal, Ulbak and Ørnsholt described a patient with a hernia defect superolateral to the inguinal canal; however, a loop of the spermatic cord was adhered to the hernia sac, which penetrated the abdominal wall through the internal aperture of the inguinal canal.…”

“…Vereb-Amonlini et al proposed the term “lateral direct hernias” to encompass this group of hernias, along with the intraparietal hernias, but not including spigelian hernias [ 12 ]. Weber Sanchez et al suggested to simply group them as “peri-inguinal hernias.” [ 10 ]. Regardless of the term used, we agree that a uniform and defined classification of these hernias is necessary for practical purposes.…”

“…This case report represents the first totally extraperitoneal repair with mesh (TEP) of a para-inguinal hernia. Several other authors have described a transabdominal approach to repair of para-inguinal hernias in recent years [ 7 , 10 , 11 , 12 , 14 ]. A minimally invasive laparoscopic approach also offers the advantage of evaluation and treatment of other hernias, which is particularly beneficial given the relatively high incidence of patients with multiple hernias [ 15 ].…”