A 65 year old male presented with a symptomatic, recurrent right inguinal hernia. The patient had two prior open right inguinal hernia repairs at an outside hospital, the last using two Perfix^TM mesh plugs.

A laparoscopic transabdominal pre-peritoneal approach was planned. Because the patient had undergone a prior open right colectomy, initial access was achieved in the left mid abdomen using a Veress needle; three laparoscopic ports were utilized.

Adhesions to the abdominal midline were released and a pre-peritoneal flap was created from the posterior abdominal wall down to the recurrent indirect hernia defect. The peritoneum was densely adherent to the mesh plugs which precluded maintaining an intact peritoneal flap, and the plugs had to be partially excised to allow the planned mesh to lay flush along the pelvic floor. A 17 X 12 cm Gore ePTFE DualMesh® was placed over the inguinal floor and hernia defect and was secured in place with a tacking device. The peritoneal edge was sutured to the inferior border of the mesh to avoid herniation underneath the free, nontacked inferior margin. The patient was kept in the hospital overnight due to the adhesiolysis and had an uneventful postoperative recovery.

The repair of recurrent inguinal hernias in the setting of prior mesh plug repair presents a challenge for the general surgeon. The transabdominal laparoscopic repair can be utilized in this setting but is difficult because of scarring in the preperitoneal space from the mesh plug(s).