Abstract
A 74-year-old man, had undergone right external inguinal hernia repair with a mesh plug. After the operation, he had persistent right inguinal pain. Six months postoperatively, he complained of inner thigh pain along with persistent right inguinal pain, and physical examination revealed a recurrent right inguinal hernia. Surgery was performed 7 months after the initial operation. Laparoscopic observation showed that the recurrence was due to an internal inguinal hernia (type II-1). The plug was removed laparoscopically, and the inguinal canal was opened via an anterior approach. The onlay patch was flipped over on the pubic bone, and recurrence was found in the same area. The cause of chronic pain was adherence of the iliac hypogastric nerve to the onlay patch. The onlay patch was removed, and the iliac hypogastric nerve excised. After closing the incision, the hernia was again repaired laparoscopically via transabdominal preperitoneal approach. After the operation, the chronic pain disappeared. At 1 year postoperatively, there has been no recurrence of chronic pain or inguinal hernia. The combination of laparoscopic surgery and an anterior approach was useful in this case.
