Peritoneal Pocket Hernia—Avoidable Complication Following TAPP with Meticulous Closure Technique of Peritoneal Flaps

The paper presents the case of a young woman, 29 years of age recently operated by TAPP for right inguinal hernia, who was readmitted to our clinic for intense pain in the lower abdominal floor and right iliac fossa with features of intestinal obstruction of 24 h of duration. Intraoperatively, we observed intestinal occlusion due to an incarcerated ileal loop at the level of a peritoneal gap of approximately 2 cm in diameter, in the flap suture area, after transabdominal preperitoneal patch technique (TAPP). Moreover, the phlegmonous appendix was encountered in the properitoneal space, fixed at the level of the polypropylene mesh. Appendectomy and peritoneal defect closure were performed, with quick postoperative recovery. In recent years, minimally invasive techniques are increasingly being adopted for the repair of inguinal hernias because in addition to the rapid recovery and aesthetic advantage they are associated with a low risk of complications, and the use of the net meshes reduces the recurrence rate to 1–6%. In the case presented, the early postoperative complication was major and rare, associating intestinal obstruction with ileal loop incarceration in a peritoneal breach with acute phlegmonous appendicitis. This complication could be easily avoidable with meticulous closure of peritoneal flap after the TAPP procedure, preventing the contact between the intraperitoneal viscera and the mesh. In any patient following laparoscopic surgery, relaparoscopy must be performed sooner rather than later for timely diagnosis and management of a complication.