Purpose : The aim in this study was to clarify the issues experienced with groin hernia treatment by examining the changes in groin hernia repair technique selection and surgical results in our department since 2013 with the introduction of the transabdominal preperitoneal repair (TAPP) method. Materials and Methods : In this retrospective study, we examined 1,898 adult groin hernia repairs performed in our department between April 2013 and March 2023. Results : The TAPP method was performed in the highest number of all cases, with 9 recurrences out of 1,359. No recurrence has been observed after July 2017. A comparison of the outcomes of 1,814 elective and 84 emergency surgeries showed that the proportion of recurrences and complications of Clavien-Dindo classification grade ≥II was higher in the emergency surgery group (p<0.01). Conclusion : To improve outcomes, appropriate and improved surgical techniques must be selected and patients must be educated to undergo surgery prior to incarceration.

Spontaneous anterior interosseous nerve palsy (sAINP) is a peripheral nerve disorder of unknown cause. It often appears suddenly and can be associated with viral infections, stress, overuse injuries, surgery, or trauma. We report a rare case of sAINP following breast cancer surgery. A 55-year-old Japanese woman underwent breast-conserving surgery and axillary lymph node dissection for right breast cancer. Postoperative diagnosis revealed stage IIA (pT1c N1 M0) disease. Her recovery was uneventful, and she was discharged seven days post-surgery. However, on postoperative day 20, she developed pain in her right elbow joint. Two weeks later, a characteristic “teardrop sign” appeared, characterized by hyperextension of the thumb's interphalangeal joint and inability to flex the index finger's distal interphalangeal joint. Upper limb nerve ultrasonography confirmed swelling of the anterior interosseous nerve on the affected side. Needle electromyography indicated a nerve disorder pattern, suggestive of inflammation. Based on these findings, including typical pattern of muscle involvement and evidence of inflammatory neuropathy, the diagnosis of sAINP was established. We will include a literature-based discussion in this report.

A 76-year-old woman presented to our hospital with a lump in her left breast. Ultrasonography and computed tomography revealed an irregular 19 mm mass in the left breast and enlarged left axillary lymph nodes. Core needle biopsy of the breast mass diagnosed HER2-positive squamous cell carcinoma (cT2N2M0, ER-negative, low PR expression (10%), HER2 : 3+, Ki-67 : 60%). She received neoadjuvant chemotherapy with trastuzumab (HER) and pertuzumab (PER), followed by total mastectomy with axillary lymph node dissection (Level III). Postoperative pathology confirmed the effectiveness of anti-HER2 therapy (ypT1c N2aM0, ER-negative, PR-negative, HER2 : 3+, Ki-67 : 10%, grade 1b histological therapeutic effect). Adjuvant combination therapy with HER and PER maintained a disease-free state for 16 months after surgery. However, new metastases were found in the bilateral lungs and mediastinal lymph nodes. These metastatic lesions responded well to trastuzumab emtansine therapy. This case demonstrates that anti-HER2 therapy can be effective in prolonging survival in patients with HER2-positive squamous cell carcinoma of the breast.

A 53-year-old woman presented to the emergency department with progressive difficulty moving her lower limbs, which significantly impacted her daily life. Brain magnetic resonance imaging showed no abnormalities, but her symptoms persisted. Due to dyspraxia, dysarthria, and horizontal nystagmus, she was admitted for further evaluation and referred to the neurology department. On the same day, a computed tomography scan revealed a 2 cm mass in the left breast and an enlarged lymph node in the left axilla. Suspected of having breast cancer, she was referred to our department for evaluation and treatment. Aspiration biopsy of the breast mass confirmed invasive ductal carcinoma, and cytology of the axillary lymph nodes revealed metastatic carcinoma. Additionally, blood tests showed positivity for the anti-Yo antibody. Based on these findings, a diagnosis of breast cancer with paraneoplastic cerebellar degeneration was made. Left mastectomy and axillary lymph node dissection (level I/II) were then performed. The pathological stage was determined to be pT2N2M0 Stage IIIA ER (weakly positive), PgR (-), HER2 (3+), and Ki-60 60-70%. Following surgery, the patient received pulse steroid therapy, anti-HER2 therapy, intravenous immunoglobulin, and cyclophosphamide pulse therapy. This treatment regimen led to gradual improvement in her ataxic symptoms and dysarthria.

Benign metastasizing leiomyoma (BML) is a rare disease where uterine leiomyomas most frequently metastasize to the lungs. Here, we present a case of BML in a 67-year-old woman who underwent hysterectomy at the age of 36 for uterine leiomyomas and thyroidectomy at 40 for thyroid cancer. Bilateral multiple lung nodules developed, which were initially considered as lung metastases of thyroid cancer, and the patient had been followed-up for about 27 years after thyroid surgery. Despite being asymptomatic, a partial enlargement of one lung nodule prompted the performance of a video-assisted thoracoscopic left lung biopsy for diagnostic confirmation and further management. Pathological examination revealed spindle-shaped cells without atypia, and immunohistochemistry demonstrated estrogen and progesterone receptor positivity, leading to the diagnosis of BML in the lungs. In cases of bilateral multiple lung nodules in women with a history of uterine leiomyomas, BML should be considered.

The patient 1 was a 66-year-old man. He presented to our emergency department with left facial swelling which developed on the same day after he received dental treatment for the left lower molar teeth. He was admitted to our hospital for follow-up after a CT scan showed emphysema extending from the left cheek to the superior mediastinum. He was discharged on independent gait after rest and antibiotics treatment, and his symptoms have not worsened since then. The patient 2 was a 63-year-old man. He was treated for periodontal disease of the left lower molar teeth, and had swelling and pain in the left buccal region. Due to worsening of symptoms, he presented to our emergency department on the next day. A CT scan showed subcutaneous and mediastinal emphysema from left cheek to bilateral sides of neck, but his symptoms and findings were mild. He was treated with oral antibiotics and sent home. His symptoms have not worsened since then.

Mediastinal emphysema is commonly caused by a trauma or in association with spontaneous pneumothorax, and is widely known to physicians treating respiratory diseases. However, it is not well known that dental treatment is a cause of mediastinal emphysema, and we report these cases with some reviews of the literature.

The patient was a 44-year-old asymptomatic man. Chest computed tomography during complete medical health checkup showed a tumor in the anterior mediastinum. ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed FDG uptake with a maximum standardized uptake value of 3.2. Chest enhanced computed tomography showed a 1.1×0.8×1.3-cm well-circumscribed nodule in the anterior mediastinum with contrast enhancement. Malignant tumor such as thymoma, malignant lymphoma, and germ cell tumor could not be ruled out with preoperative examinations. We performed partial resection of the thymus with video-assisted thoracic surgery, and microscopically confirmed cholesterol clefts, multinucleated giant cells, and histiocytes. The pathological diagnosis was cholesterol granuloma. Cholesterol granulomas commonly develop in the middle ear and paranasal sinuses and those arising in the thymus are rare. Imaging diagnosis of mediastinal cholesterol granuloma is challenging and surgical resection and pathological diagnosis are needed.

A 69-year-old man, who underwent laparoscopic total gastrectomy (LTG) for gastric cancer 7 years earlier and had completed 5 years of follow-up with no recurrence 2 years earlier, presented to the emergency department with acute epigastric pain. Thoraco abdominal computed tomography showed the small intestine protruded into the mediastinum. A diagnosis of incarcerated esophageal hiatal hernia (EHH) was made, and emergency laparoscopic surgery was performed because no signs of bowel perforation or dilation were observed. Intraoperative findings showed that the small intestine including the Y anastomosis protruded into the mediastinum through the widely opened esophageal hiatus. Hernia repair could be performed by pulling out the herniated bowel gently. After reduction of the small intestine, suture cruroplasty and jejunopexy to the diaphragm were performed. There were no postoperative complications, and the patient was discharged on the 9th postoperative day. No recurrence of gastric cancer as well as EHH occurred after 2 years of follow-up. Although EHH incarceration is relatively rare, it may occur even a long time after LTG. Besides taking infraoperative preventive measures for EHH, careful observation considering EHH repair before hernia incarceration is necessary when EHH is found during postoperative follow-up.

A 45-year-old woman presented with severe vomiting after dinner followed by back and chest pain. She was referred to us with the diagnosis of idiopathic esophageal rupture. A contrast study via a gastric tube revealed a rupture of the esophagus at its lower left side and a chest computed tomography revealed a giant mediastinal abscess accompanied by a contrast leakage and a moderate amount of left pleural effusion free from contrast. Her disease was diagnosed as contained rupture of the esophagus. She was operated on under two-lung ventilated general anesthesia in the right semilateral position. The abscess was drained by a laparoscopic transhiatal approach and lavaged with saline. Subsequently, a thoracoscopic exploration was performed via two port sites. It disclosed turbid effusion and enabled an adequate pleural lavage and drainage. A very small amount of extraluminal leakage was noted on an esophagogram on the 7th postoperative day which disappeared on the 14th. The patient was discharged home on the 22nd.

A contained rupture of the lower esophagus can be adequately drained by laparoscopic procedure, however, such cases may require an additional pleural exploration. A decubitus of right semi-lateral position would be suitable for this condition.

The frequency of esophageal diverticulum in Japan is about 1.6%. Carcinoma in esophageal diverticulum is very rare, occurring in comprising 0.6% of the cases. Epiphrenic esophageal diverticulum is a pseudodivertilulum that lacks the muscularis propria, thus a carcinoma arising in it can easily invade surrounding organs. In addition, they lack symptoms such as transit disturbance, and are more likely to be detected in an advanced stage with poorer prognosis. A 72-year-old woman underwent a routine medical checkup for an epiphrenic diverticulum. Six years later, upper gastrointestinal endoscopy revealed a 20-mm-sized 0-IIb lesion recognized as a clear iodine unstained area in the diverticulum. A biopsy revealed squamous cell carcinoma and a diagnosis of cT1a-EP/LPM, N0, M0, cStage 0. Esophageal manometry showed no abnormal findings. Endoscopic resection was considered, but surgical resection was decided because of chronic cough, reflux esophagitis, and proximity of the tumor margin to the diverticular orifice. Thoracoscopic radical subtotal esophagectomy was performed and R0 resection was obtained. The pathological diagnosis was pT1a-MM, N0, M0, fStage 0. We experienced a case in which surgical radical resection was possible by early detection of carcinoma in epiphrenic diverticulum with periodic observation. This case is reported with some discussion of the literature.

A 78-year-old woman was found to have a submucosal tumor in the posterior wall of the greater curvature of the upper gastric corpus in December 2018. Investigations showed that this was a gastric lipoma, and a policy of watchful waiting was adopted. In July 2022, she presented at a local clinic with palpitations and lightheadedness. She was found to be anemic, with a Hb of 4.1 g/dl, and she was referred to our hospital. Emergency upper gastrointestinal endoscopy showed a submucosal tumor with an apical mucosal defect exposing the lipoma, and blood residue was present in the stomach. Although hemostasis had occurred spontaneously, the lipoma's diameter had enlarged to 65 mm, and because of the risk of rebleeding, classical laparoscopic-endoscopic cooperative surgery (LECS) was performed. The diagnosis on histopathological examination was gastric lipoma. Watchful waiting is the usual strategy for gastric lipoma, but resection is necessary should symptoms such as bleeding or obstruction occur, or if there are signs suggestive of malignancy, and the resection method must take into account tumor diameter and location. Use of classical LECS to remove a hemorrhagic gastric lipoma is reported.

A 53-year-old man with a history of duodenal ulcer perforation treated with subtotal gastrectomy and Roux-en-Y reconstruction was admitted to our hospital with acute abdominal pain. Emergency surgery was performed for small bowel necrosis associated with aortic dissection. In the initial surgery, partial small bowel resection with a remaining gastric blind end and creation of a double-barreled stoma with jejunostomy and ileostomy were performed. In the second surgery, subtotal small bowel resection, gastrocolic anastomosis, and jejunoileal anastomosis were carried out. Subsequently, an enterocutaneous fistula formed from the site of incomplete suturing at the jejunoileal anastomosis to the ex-stoma site. Negative pressure wound therapy was applied to manage this condition, resulting in the successful conservative closure of the fistula. This case is presented along with a review of the relevant literature.

A 75-year-old man presented with hemorrhagic shock and abdominal pain due to a puncture-site hematoma following percutaneous coronary intervention. An abdominal computed tomography (CT) scan revealed hepatic portal venous gas (HPVG). Laboratory data demonstrated metabolic acidosis. As non-obstructive intestinal ischemia was unable to be ruled out, an emergency surgery was performed. No intestinal necrosis was found. On postoperative day 1, an abdominal CT scan revealed HPVG resolution. After the patient began oral food intake on hospital day 21, bloody stools were observed. Lower gastrointestinal endoscopy revealed an ulcer and exposed blood vessels in the distal ileum and stenosis of the proximal small intestine. Although he resumed oral food intake, abdominal pain and distension developed, and obstruction due to ischemic enteritis of the stricture type was diagnosed. On hospital day 40, resection of the thickened and constricted portion of the distal ileum was performed. In treating ischemic enteritis presenting with HPVG, we need to keep in mind that ischemic changes extend deep into the submucosa and that small bowel stenosis may occur late during the repair process.

The patient was a 48-year-old woman who presented with upper abdominal pain. She had no history of abdominal surgery, and an abdominal CT scan revealed intestinal stenosis from the horizontal leg of the duodenum to the upper jejunum, and dilatation of the intestinal tract on the proximal side. She was diagnosed with simple intestinal obstruction, and although she was placed on an indwelling gastric tube, given intravenous fluids, and started fasting, no improvement was observed, and an diagnostic laparoscopy was performed on the 8th hospital day. The small intestine from the duodenum to the terminal ileum was intruded into a hernial orifice created by adhesion between the mass in the upper jejunum and the descending mesocolon. After adhesions were removed, the jejunum including the mass was resected in a full-thickness wedge. A diagnosis of foreign body granuloma was made based on histopathological findings. Although the type of foreign body could not be determined, the patient had no history of abdominal surgery and preferred seafood, suggesting a foreign body reaction to food such as fish bones. We report a case of intestinal obstruction due to jejunal foreign body granuloma.

One year earlier, a 58-year-old man noticed swelling in the right lower abdomen. Abdominal computed tomography (CT) showed an abdominal wall abscess continuous with the appendix, and linear calcification was observed inside. At that time, the symptoms improved with conservative treatment. However, due to repeated recurrence and disappearance, surgery was performed. The root of the appendix was ligated and dissected with a laparoscope, and the appendix was removed together with the surrounding abdominal wall. The skin just above the abscess was incised and drained. Since a fish bone was found in the appendix, it was determined that the source of infection had been removed, and the operation was terminated. The patient's postoperative course was uneventful, and the patient was discharged from the hospital on the 6th day. A case of appendicitis due to fish bone abscess formation in the abdominal wall, which underwent both laparoscopic and local approaches, is reported, along with a review of the relevant literature.

We report two operated cases of appendiceal goblet cell adenocarcinoma (AGCA) presented with acute appendicitis. The patient 1 was a 74-year-old woman who presented to our hospital with vomiting and abdominal pain. Imaging studies revealed acute appendicitis with perforation. Appendectomy and intraperitoneal drainage were performed. The histopathological diagnosis was AGCA. The patient 2 was a 39-year-old man. He underwent interval appendectomy (IA) after conservative treatment for complicated appendicitis with an abscess. The histological diagnosis was AGCA. Therefore, laparoscopic ileocecal resection and lymph node dissection were performed after the first operation.

Conservative treatment followed by IA is a useful management for complicated acute appendicitis. However, surgeons should keep mind on appendiceal tumor in cases of complicated appendicitis especially in middle-aged and elderly patients who might have hidden malignancy. Preoperative colonoscopy and IA are necessary after conservative therapy for complicated appendicitis.

A 20-year-old-woman was admitted to our hospital due to lower abdominal pain, with suspected repeat ovarian bleeding. Two days later, she underwent emergent laparotomy for suspected colonic perforation. Since the serosal surface, as well as the colonic stump, was very fragile, and refractory oozing bleeding and subserosal hematomas were seen, open abdominal management was performed. Two days later, the abdominal wall was closed by suture, and a transverse colostomy was created after confirming neither bleeding nor organ necrosis. Although the patient's postoperative course was uneventful, sudden bleeding via the drainage tube was found 7 days after re-operation. Contrast-enhanced CT and angiography showed rupture of the left gastric artery and an aneurysm of the common hepatic artery. Coil embolization was successfully performed. However, the patient died due to repeat intra-abdominal bleeding just after re-admission to the intensive care unit. This patient was finally diagnosed as having vascular Ehlers-Danlos syndrome (vEDS) genetically and clinically by the major criteria of colon perforation and intra-abdominal aneurysm, as well as the minor criteria of joint hypermobility and dislocation. This rare case of vEDS is presented along with a review of the relevant literature.

Lymphangioma commonly occurs in children in the head and neck region, and it is rarely seen in adults or in the mesentery. A 20-year-old woman presented to the emergency department complaining of right lower abdominal pain. On investigation, WBC was 11,700/μL, CRP was 6.56 mg/dL, and computed tomography showed a 100-mm, multilocular cystic mass in the right abdomen. On imaging, the mass was starting to enclose the ileocolic artery and vein, but it did not pass the right margin of the superior mesenteric vein, maintained clear margins with adjacent organs, and had no evident solid component. The differential diagnosis included lymphangioma, mucinous cystic adenoma, and cystic mesothelioma, and it was decided to resect the mass for both therapeutic and diagnostic purposes. When the abdomen was opened, the lesion was seen within the right mesocolon, and en bloc right hemicolectomy was conducted. Histologically, the cyst consisted of an irregularly dilated large vessel lined by simple epithelium that was positive for CD31 and D2-40, but negative for CD34, resulting in a diagnosis of lymphangioma. One year later, the patient remains recurrence-free. This case is reported along with an analysis and discussion of previous reports of adult mesocolic lymphangioma in Japan.

A 48-year-old man was referred to our hospital because of lower abdominal pain and bloody stools since the day before his arrival. Abdominal computed tomography showed a target sign in the splenic flexure and numerous aerobic cysts on the oral side of the colon, which led to the diagnosis of intussusception by pneumatosis cystoides intestinalis (PCI). Based on the poor contrast of the intestinal wall and the intra-abdominal free gas, the possibility of gastrointestinal perforation was considered, and emergency surgery was performed. Surgical findings showed that the transverse colon had aerobic cysts and intussusception in the splenic flexure. Since manual repair of the intussusception was difficult, a partial colonic resection was performed to avoid residual aerobic cysts. Because the resected colon showed microperforation, and the histopathological findings were consistent with PCI, gastrointestinal perforation due to intussusception associated with PCI was diagnosed. Intussusception by PCI often occurs in the right side of the colon, but in this rare case, gastrointestinal perforation due to intussusception by PCI occurred in the left side of the colon. This case is reported along with a review of the relevant literature.

We have experienced a case of strangulated intestinal obstruction due to the reconstructed intestinal tract and pelvic wall after laparoscopic assisted sigmoidectomy. The patient was an 80-year-old woman. She underwent laparoscopic assisted sigmoidectomy at another hospital 5 years previously. The patient was brought into our emergency room due to sudden onset of abdominal pain and nausea. Abdominal CT scan revealed dilation and a closed loop of the small intestine in the pelvis, and a diagnosis of strangulated intestinal obstruction due to postoperative adhesions was made. Emergency surgery was performed. The small intestine had entered a gap formed between the reconstructed intestinal tract and the anterior surface of the sacrum and had become constricted. The necrotic intestine was partially resected. Even in laparoscopic surgery, depending on the case, it is necessary to consider techniques that do not create a gap between the intestinal tract and the pelvic wall, or that close the gap.

A 76-year-old man was diagnosed with adenocarcinoma of the rectum and received neoadjuvant radiotherapy (25 Gy/5 fr). After the start of radiotherapy, he underwent laparoscopic abdominoperineal resection (Lap-APR) with right side lateral lymph node dissection (ypT3N1bM0 ypStage IIIb). In addition to the surgery, he was given four cycles of postoperative adjuvant chemotherapy with CAPOX. Twenty months after the surgery, however, contrast-enhanced CT showed an abnormality in S7 of the liver, for which he underwent laparoscopic segmental liver resection. He then received seven cycles of adjuvant chemotherapy with capecitabine. At 43 months after the Lap-APR, a penile tumor was suspected because contrast-enhanced CT showed an abnormal high-density area in the left side of the penis. A biopsy of the corpus spongiosum showed adenocarcinoma, and based on the results of immunohistochemical (IHC) staining, he was diagnosed with metastatic penile cancer from colorectal adenocarcinoma. He decided to receive chemotherapy again with FOLFOX plus panitumumab, and tumor shrinkage was seen after six cycles of the chemotherapy.

A 60-year-old man was brought into our hospital in poor general condition due to abdominal distention caused by intestinal dilatation. We attempted deglutition to the patient by inserting a colonoscope and placed a transanal ileus tube, but we failed to improve his symptoms. We diagnosed the case as Ogilvie's syndrome and created a double-barrel stoma in the transverse colon and the patient achieved improvement. After improvement of intestinal dilation, close examination revealed the presence of intestinal malrotation. Ogilvie syndrome is a rare disorder that results in colorectal stricture due to bowel passage obstruction. Due to the extreme rarity, we report a case of Ogilvie's syndrome associated with intestinal malrotation, which was relieved by colostomy.

A 32-year-old man was admitted to our hospital because of anal pain. Digital rectal examination and colonoscopy showed an anal canal tumor, and pathological examination confirmed that the tumor was adenocarcinoma. Radical surgery was recommended because no distant metastasis was found, but he strongly desired preservation of the anus. Therefore, total neoadjuvant therapy (TNT) was selected as the initial treatment. He was treated with three cycles of CAPOX (capecitabine 3,600 mg/day on days 1-14, oxaliplatin 130 mg/m² on day 1, every 3 weeks) plus bevacizumab (7.5 mg/kg on day 1, every 3 weeks), followed by chemoradiotherapy (radiation therapy at 59.4 Gy/33 fractions and oral capecitabine 825 mg/m² twice daily for 5 days per week) and two cycles of capecitabine (4,200 mg/day on days 1-14 every 3 weeks). Post-treatment colonoscopy and magnetic resonance imaging showed clinical nearly complete response, and pathological examination showed no malignant findings. Surgical treatment was again recommended to the patient and his family, but they strongly preferred careful follow-up. Currently, 1 year and 3 months after TNT, no evidence of regrowth or metastasis has been detected.

A 72-year-old woman had undergone pancreaticoduodenectomy (PD) in our hospital for distal bile duct cancer (pT2N0M0, Stage IIA). A computed tomography image of the abdomen captured thirty months after the initial surgery revealed right intrahepatic bile duct dilatation and hilar bile duct stenosis. Endoscopic retrograde cholangiopancreatography revealed stenosis of the right hepatic duct, and adenocarcinoma was detected in the endoscopic biopsy sample. Based on the diagnosis of perihilar cholangiocarcinoma originating from the right hepatic duct, a right caudate lobectomy and a left biliary tract reconstruction were performed. The resected specimen revealed a tumor in the right hepatic duct. Histopathological diagnosis of the tumor was a well-differentiated adenocarcinoma (pT2bN0M0, Stage II) ; however, the surgical margin of the left hepatic duct was histologically positive (HM1, R1). The patient showed lymph node metastasis 11 months after the second surgery. She died of the disease, thirty-one months after diagnosis.

A 37-year-old woman presented with a cystic lesion in the pancreatic tail. Abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) revealed a 20-mm cystic mass in the tail of the pancreas. Additionally, endoscopic ultrasound (EUS) revealed a 25-mm structure with a cyst-like appearance, suggesting an intraductal papillary mucinous neoplasm (IPMN). She delivered her first child at 37 years of age. Abdominal CT performed 6 months after delivery revealed that the cystic mass had grown to 35 mm, with atrophy of the pancreatic tail and dilation of the main pancreatic duct. EUS revealed an enlargement of the cystic mass ; therefore, a laparoscopic distal pancreatectomy was performed. The postoperative course was uneventful ; the patient was discharged on the sixth day. Histopathological findings revealed that the cyst was lined by a poorly defined atypical cylindrical epithelium and ovarian-like stroma below the epithelium, consistent with a mucinous cystadenoma. No apparent recurrence was observed at follow-up, and the patient later gave birth to her second child without complications. Pregnancy may rapidly increase the size of mucinous cystic neoplasms (MCN). Thus, monitoring patients carefully during follow-up and considering possible surgery for patients who are pregnant is necessary.

A 70-year-old man underwent laparoscopic inguinal hernia repair at our hospital. Laparoscopic findings revealed bilateral external inguinal hernias (right : L2 type, left : L1 type). Transabdominal preperitoneal hernia repair (TAPP) was performed bilaterally. The patient was discharged from the hospital without any complications on the third postoperative day. Two months after the TAPP, the patient developed an intestinal obstruction and was readmitted to our hospital. No improvement was observed with conservative treatment ; therefore, surgery was performed. Intraoperative findings showed that the peritoneal suture in the right inguinal region had separated, and the small intestine had adhered. The adhesions were laparoscopically removed. Because the peritoneum could not be repaired due to the strong adhesion to the surrounding tissues, the peritoneal defect was covered with an adhesion-prevention mesh (Ventralight ST, Bird). The patient was discharged without complication on the seventh postoperative day. After nine months, neither hernia nor intestinal obstruction reoccurred. Herein, we report a case of intestinal obstruction after TAPP, along with a literature review.