Sliding lipoma: an indirect inguinal hernia without a peritoneal sac

With the increasing application of endoscopic hernioplasty, surgeons have now recognized that the peritoneal sac is sometimes absent in patients who present with a reducible inguinal hernia. Sliding lipoma refers to a sliding herniation of preperitoneal fat into the inguinal canal forming a reducible indirect inguinal hernia in the absence of a peritoneal sac. In this report, we describe a patient who underwent bilateral endoscopic totally extraperitoneal inguinal hernioplasty (TEP), followed by an early recurrence of left inguinal hernia, secondary to a sliding lipoma. Sliding lipoma is a challenging condition specific to endoscopic repair of inguinal hernia. All lipomas should be reduced and excised whenever feasible. Awareness and appropriate management of the sliding lipoma will help to reduce the risk of recurrence after endoscopic hernioplasty.