Step-by-step guide to safe removal of pre-peritoneal inguinal mesh.

BACKGROUND

Inguinal hernia repairs are among the most common operations performed worldwide. An increasing number is performed minimally invasively with mesh placed pre-peritoneally. Some situations may require mesh removal. This can be complex and challenging. We share our technique to remove pre-peritoneal mesh using a minimally invasive approach.

METHODS

The multiple steps involved in robotic-assisted pre-peritoneal mesh removal are reviewed in detail, including preoperative planning, intraoperative positioning, review of anatomic landmarks, and systematic approach with technical tips to reduce complications.

RESULTS

We provide an attached narrated video guide with a written summary to outline pre-peritoneal inguinal mesh removal. The steps are applicable to both robotic-assisted and laparoscopic approaches. We present a video of the robotic-assisted approach. We prefer the robotic-assisted approach for most pre-peritoneal mesh removal based on results of our retrospective series of 26 patients undergoing 31 mesh removals. We noted that our robotic-assisted approach was more effective than the laparoscopic approach, with significantly less incidence of vascular injury (0 vs 5, p < 0.05) and less nerve (1 vs 4) and spermatic cord injuries (0 vs 1).

CONCLUSIONS

As pre-peritoneal inguinal mesh implantation becomes more popular, surgeons may be seeing more patients with complications who may require mesh removal. We provide a detailed step-by-step approach with video to serve as a guide to surgeons who are planning for safe removal of pre-peritoneal inguinal hernia mesh.