Abstract
Objective : This study evaluated the diagnosis and laparoscopic surgical (TAPP) repair of sliding indirect inguinal hernias (sliding IIHs).
Methods : Of 317 unilateral IIHs repaired by TAPP, 27 were sliding types and 290 were non-sliding types. The sliding type IIHs were further classified based on laparoscopic findings into 21 standard types, in which viscus formed part of the hernia sac, and 6 complete types, in which the viscus was adherent to the entire hernia sac.
Results : Computed tomography (CT) findings of colon protrusion were seen in all sliding type IIHs, at a rate that was significantly higher than 6% in non-sliding IIHs. Circular incision of the hernia orifice was possible in 10 of the standard type cases. In the remaining 11 standard type and all complete type cases in which circular incision was difficult, the vas deferens and gonadal vessels were first identified on the ventral side, and this followed by a superior margin incision (SMI) of the hernia orifice to dissect the posterior surface of the sac from the inguinal floor. No intraoperative complications occurred with an SMI, and operative time did not significantly differ from that with a circular incision.
Conclusion : CT findings of colon protrusion are useful in the preoperative diagnosis of a sliding IIH. TAPP using an SMI is useful in cases where a circular incision is difficult.
