Endoscopic extraperitoneal inguinal hernia repair with double mesh: indications, technique, complications, and results.

Although totally extraperitoneal laparoscopic hernia repair has the same benefits attributed to the traditional preperitoneal prosthetic surgical repair, this procedure is not used widely because of perceived difficulty in dissection. Since one of the most common causes of hernia recurrence in this procedure is inadequate lateral inferior and medial inferior mesh fixation, we have introduced a double-mesh technique in an effort to reduce the rate of recurrence. Our procedure is a variation of the totally extraperitoneal laparoscopic inguinal hernia repair and provides a more secure inguinal floor by adjusting the second mesh to the area of weakness. We describe the laparoscopic inguinal hernia repair by the extraperitoneal double-mesh technique performed in 53 selected patients with very large indirect hernias and extremely large bilateral or recurrent hernias. The mean operative time was 74 minutes for unilateral hernias and 110 minutes for bilateral hernias. The median follow-up time was 65 months (range, 9-97 months) with no recurrences, neuralgia, or bleeding complications. We believe that this technique offers perfect positioning of the meshes and provides the most secure inguinal floor. Therefore, the method is presented for consideration in the laparoscopic repair of large indirect, direct, or recurrent hernias.

True aneurysm of brachial artery.

True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms.