P132 TRANSABDOMINAL PREPERITONEAL REPAIR (TAPP) FOR DE NOVO TYPE INGUINAL HERNIAS

Abstract Aim In Japan, the de novo type inguinal hernia is defined as a hernia that develops without being related to the vaginal process of peritoneum. The pathological condition of a de novo type hernia is considered similar to that of a sliding hernia. the aim of this study is to discuss about the operative procedure for de novo type inguinal hernia, with a particular focus on lipomas. Material and Methods We examined surgical procedures, rate of combined lipoma, postoperative complications, and recurrence rates of de novo cases among TAPP cases performed in our department from 2018 to 2020. Results We performed 230 TAPP repairs during the period, included 56 de novo type hernia. 19 cord lipomas were found in de novo type hernias but none in non de novo type hernias. The lipomas prolapsed from the lateral side of the internal inguinal ring in 6 cases, medial side in 9 cases, In 4 cases, lipoma or lipomatous tissue were embedded in the spermatic cord and they could not be extracted. There were no postoperative complications. The average postoperative hospital stay was 1.2 days. There were no chronic pain nor recurrence. Conclusions It is important to note that the de novo hernia is associated with a high incidence of lipoma. Since lipomas are often attached to the peritoneum, dissecting the peritoneum at the internal inguinal ring has the risk of missing the presence of lipomas, and in de novo hernias, the peritoneum must be pulled out.