Here, we report a case of laparoscopic trans-inguinal hernia repair (transabdominal preperitoneal repair or TAPP) for a recurrent inguinal hernia following direct Kugel surgery. A 71-year-old man underwent direct Kugel hernioplasty for a right inguinal hernia at another hospital 4 years prior to presentation. The patient subsequently underwent laparoscopic surgery using the TAPP technique, during which the abdominal cavity was visualized with a laparoscope, revealing a tubular mesh protruding towards the abdominal cavity with a direct and indirect hernia ring. Three months post-surgery, no recurrence was observed.

We present a case of a recurrent inguinal bladder hernia that was previously unsuccessfully operated on three times and was repaired using totally extraperitoneal repair (TEP). A 79-year-old man presented with a right inguinal swelling that had been treated three times on the same side with anterior approaches. Computed tomography confirmed a recurrent inguinal bladder hernia. TEP was performed after identifying the bladder hernia preoperatively, with previous surgeries that used a plug-and-patch technique through an anterior approach. The extraperitoneal approach allowed the bladder to be reduced without injury and the hernia to be safely repaired using a 3D Max® Light Mesh. The postoperative recovery was uneventful, with no recurrence after 1 year. TEP facilitates the diagnosis and repair of bladder hernias, emphasizing the importance of preoperative diagnosis and the efficacy of endoscopic procedures in bladder hernia repair, even in recurrent cases.

BACKGROUND: Amyand\'s hernia (AH)-where the appendix becomes incarcerated within the inguinal hernia (IH) sac-is rare, particularly if detected and operated concurrent with a contralateral recurrent IH.
METHODS: A 65-year-old man presented with symptomatic bilateral IH; the left IH was recurrent. Abdominopelvic computed tomography (CT) revealed a right IH with appendiceal herniation and left recurrent IH with omental fat. Using the prolene hernia system (PHS) mesh, the left recurrent IH underwent operation, followed by the right AH. The patient was in a good state with no recurrence 16 months postsurgery.
CONCLUSIONS: If AH is accidentally encountered during surgery, the procedure should differ depending on the inflammatory state of the appendix. Simultaneously operating AH and contralateral recurrent IH is complicated; it is necessary to preoperatively decide which side to operate on first and whether to use an anterior or laparoscopic posterior surgical approach. If the planned operation is unattainable, alternative surgery should be considered. Fortunately, herein CT was performed prior to surgery, and the surgical plan was properly established.
CONCLUSIONS: Prior to simultaneous AH and contralateral recurrent IH surgery, the surgical plan should be established. If the planned surgical technique for recurrent hernia repair is not feasible, an alternative should be performed. In AH repair, different surgical methods are required depending on the presence and severity of inflammation of the appendix.

UNASSIGNED: The literature regarding size descriptions for spermatic cord lipomas is limited. The term \"giant\" is utilized loosely and seen on case reports for masses as small as 6 cm. Here we present a case of a giant left sided spermatic cord lipoma, found incidentally during a recurrent inguinal hernia repair, that measured 18 × 14 × 10 cm on final pathologic examination.
METHODS: A 59 year old male, with a history of morbid obesity and surgical history of prior bilateral inguinal hernia repair, presented with recurrent left sided groin and scrotal bulging with associated discomfort several months after the initial hernia repair. Following imaging performed on preoperative work up, the patient was brought to the operating room for a robotic inguinal hernia repair.
UNASSIGNED: Preoperative physical examination was limited due to the patient\'s body habitus which precluded a definitive diagnosis of inguinal hernia based on physical examination. Computed tomography of the abdomen and pelvis was performed with findings consistent with bilateral recurrent inguinal hernias. A bilateral robotic inguinal hernia repair was attempted. The procedure was converted to open via a groin incision when an incidental 18 cm left sided spermatic cord lipoma was discovered. An orchiectomy was ultimately performed as the mass was intimately intertwined with the spermatic cord.
CONCLUSIONS: In our case, the patient had a recurrent inguinal hernia and an incidental finding of an 18 cm spermatic cord lipoma which warranted a left orchiectomy followed by open inguinal hernia repair. We propose standardizing the term \"giant\" to include spermatic cord lipomas >15 cm.

The Kugel procedure resulted in extensive adhesion in the preperitoneal space. Performing a transabdominal preperitoneal repair (TAPP) for recurrent hernia after Kugel procedure is extremely difficult. In this case report, we present the case of a 81-year-old male who presented with recurrent inguinal hernia after Kugel procedure 8 years ago. Transabdominal laparoscopy was performed first. Indirect hernia formed inferior to the lateral edge of the previous mesh was diagnosed under laparoscopy. The patient\'s medial umbilical ligament (MUL) was big enough and could be completely released by separating the Retzius space. Finally, TAPP was successfully performed by using the MUL to create and close the preperitoneal space. No perioperative complications or hernia recurrence was observed 1 year after the surgery. Using the MUL to deal with preperitoneal problems was practical and feasible.

BACKGROUND: For recurrent incarcerated and strangulated hernias, the optimal treatment strategy for each case is needed.
METHODS: The study patient was a 70-year-old man. TAPP repair was performed for a left inguinal hernia (JHS Classification II-1) 7 years earlier. The patient experienced transient pain and swelling of the left inguinal region for 5 months and visited our emergency department for abdominal pain and vomiting. A CT scan showed a recurrent left inguinal hernia and small bowel incarceration, and emergency surgery was performed. Laparoscopic observation of the abdominal cavity revealed recurrent left inguinal hernia (Rec II-1) with small bowel incarceration. The small bowel was reduced after pneumoperitoneum, and no findings suggested intestinal tract necrosis. Adhesions around the herniated sac were dissected using an extraperitoneal approach and then shifted to mesh plug repair. No perioperative complications or hernia recurrence were observed in the 10 months after the surgery.
CONCLUSIONS: This report describes a novel, successful surgical treatment for a recurrent incarcerated hernia. In our patient, we could easily perform dissection and understand the positional relationship by hybrid surgery using the TEP method. Additionally, in patients with incarcerated hernias, we believe that performing hybrid surgery by combining the TEP method would be useful because bowel dilation caused by intestinal obstruction would not disturb the operative field.

BACKGROUND: The HerniaSurge Group and the European Hernia Society guidelines recommend an anterior approach to treat recurrent inguinal hernias after a failed posterior approach. The hybrid method combining explorative laparoscopy and anterior open approach can provide the benefits of both approaches.
METHODS: A 79-year-old man presented with a recurrent inguinal hernia after primary repair for an indirect hernia using the laparoscopic transabdominal preperitoneal approach (TAPP) 5 years ago. The indirect hernia formed inferior to the lower edge of the previous mesh was diagnosed under laparoscopy. The hernia defect (2 cm) was fixed using a mesh plug via the anterior approach. Appropriate mesh overlap was confirmed using laparoscopy.
CONCLUSIONS: This minimally invasive method enabled us to choose the best treatment for recurrent hernia and prevent chronic pain due to possible nerve damage caused by extended dissection of the scar tissue. Furthermore, the final confirmation step using laparoscopy assures complete coverage of all defects within the myopectineal orifice.
CONCLUSIONS: This hybrid method facilitates the choice of an optimal approach for the treatment of recurrent hernia and may reduce surgical complications and re-recurrence rate.