RT Journal
A1 Misiakos EP, Liakakos T, Preza U, Fotiadis C, Macheras A
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2009
FD June 1
VO 144
IS 6
SP 589
OP 590
DO 10.1001/archsurg.2009.69-a
UL http://dx.doi.org/10.1001/archsurg.2009.69-a
AB 
A 72-year-old patient presented with a bulging right scrotal hernia that caused worsening discomfort. The patient was a smoker and had hypertension that was being treated by medication. The hernia was repaired laparoscopically using the transabdominal preperitoneal polypropylene (TAPP) approach. At surgery the large sac of a direct hernia (with a small bowel loop within it) and the smaller sac of an indirect hernia were found. The hernia sac and its contents were reduced, and a piece of polypropylene mesh measuring 12 cm × 13 cm was placed preperitoneally and stabilized with tacks to the pubic symphysis and the pectineal ligament; thereafter, it was covered with a peritoneal patch.