Laparoscopic Totally Extraperitoneal Repair for Interparietal Sacless Sliding Fatty Inguinal Hernia: A Case Report.

Abstract

A sacless sliding fatty inguinal hernia, in which fatty tissue herniates without an accompanying peritoneal sac, is uncommon. The diagnostic challenge increases when the herniated tissue extends into the interparietal layers of the abdominal wall. We present a case of an 84-year-old female with right inguinal swelling, which was evident on physical examination but not clearly identifiable on CT imaging. Intraoperatively, using the laparoscopic totally extraperitoneal approach, no direct, indirect, or femoral hernia was observed. However, adipose tissue was found protruding from the ventral and lateral aspects of the deep inguinal ring toward the abdominal wall, resembling an interparietal hernia. The herniated tissue was successfully reduced, and a standard mesh repair was performed. Postoperatively, complete resolution of inguinal bulging was achieved. The laparoscopic totally extraperitoneal approach was found to be effective for both accurate diagnosis and definitive repair of this rare and diagnostically challenging condition.