2017 Volume 53 Issue 5 Pages 1019-1022
A 6-year-old girl with bulging of the left inguinal area since 4 years of age was referred to our department. At 5-year-8-month of age, she was diagnosed as having left indirect inguinal hernia, and radical surgery using Potts’ procedure was performed. The swelling of the left inguinal area recurred several months after the operation. Direct inguinal hernia or recurrence of indirect inguinal hernia was suspected, but differential diagnosis was difficult to make on the basis of only preoperative ultrasonography and physical examination. At reoperation, the inguinal procedure was initially used. Direct inguinal hernia was confirmed, but the observation of the internal inguinal ring was difficult owing to adhesion. Next, laparoscopy was performed, which confirmed the closure of the internal inguinal ring and the weakness of the abdominal wall of the area of the direct inguinal hernia, which matched the findings of the inguinal procedure. In addition, because the weakness of the abdominal wall was observed in a wide area extending to the vicinity of the internal inguinal ring, we decided to reinforce the abdominal wall by mesh repair via the inguinal approach. The laparoscopic procedure made it easy to identify the area of the abdominal wall weakness correctly. The postoperative course was uneventful without the recurrence of inguinal hernia.
