K S Gersin1, B T Heniford, A Garcia-Ruiz, J L Ponsky. 1. Minimally Invasive Surgery Center, Department of General Surgery, Cleveland Clinic Foundation, Department of General Surgery/A80, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: Both patients were referred for continued symptomatic groin masses, which were subsequently treated by lipoma resection in conjunction with inguinal floor repair. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: Both patients were referred for continued symptomatic groin masses, which were subsequently treated by lipoma resection in conjunction with inguinal floor repair. CONCLUSIONS: 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.
Authors: M M Poelman; B van den Heuvel; J D Deelder; G S A Abis; N Beudeker; R R Bittner; G Campanelli; D van Dam; B J Dwars; H H Eker; A Fingerhut; I Khatkov; F Koeckerling; J F Kukleta; M Miserez; A Montgomery; R M Munoz Brands; S Morales Conde; F E Muysoms; M Soltes; W Tromp; Y Yavuz; H J Bonjer Journal: Surg Endosc Date: 2013-05-25 Impact factor: 4.584