PREOPERATIVE DIAGNOSIS(ES):
Recurrent left inguinal hernia.

POSTOPERATIVE DIAGNOSIS(ES):
Neuralgia.

PROCEDURES:
1. Diagnostic laparoscopy with ilioinguinal and genitofemoral
nerve blocks performed laparoscopically.
2. Pelvic lysis of adhesions with mobilization of sigmoid colon
and surrounding adhesions.

ANESTHESIA:
General endotracheal anesthesia.

INDICATIONS FOR OPERATION:
The patient is a 56-year-old male, who had previously undergone
an open left inguinal hernia repair x2 at an outside facility.
He presented with pain in the lateral space next to his incision
and what I felt to be was a recurrent hernia. We discussed the
risks and benefits of surgery and my preferred laparoscopic
approach which would be transabdominal repair.

PROCEDURE IN DETAIL:
The patient was taken to the operating room, placed supine on the
operating table, and after adequate general endotracheal
anesthesia was given, he was prepped and draped in the usual
fashion. The Hasson technique was used to enter the abdomen at
the umbilicus and then 2 trocars were placed in the midline.
These were 5 mm trocars. There were significant adhesions with
the sigmoid colon densely adherent to the internal ring of the
inguinal canal. The splenic flexure was mobilized and lysis of
adhesions took place all the way down in the pelvis to expose
this area. This was all done with sharp dissection. No hernia
was identified, especially in the lateral space. Nonetheless,
the peritoneum was taken down medially because it was felt like
there might be a hernia there as well, but in fact, there was no
hernia identified whatsoever. Therefore, I made a decision to
inject 20 mL of Exparel which is a liposomal injectable
bupivacaine suspension to perform a nerve block of the
ilioinguinal and genitofemoral nerves hoping to give him relief.
No other abnormalities were noted. Trocars were removed under
direct vision. The Hasson port was closed using a 0 Vicryl
suture in a figure-of-eight fashion x2. Soft tissues were
irrigated and then closed using 3-0 Vicryl after which Indermil
was applied. The patient tolerated the procedure well, was
extubated at the end of the case,