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Updated: Feb 3, 2026
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Published on: March 10, 2021
Step-by-step guide to safe removal of pre-peritoneal inguinal mesh
Adam Truong1, Badr Saad Al-Aufey2, Shirin Towfigh3
1Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Background:
Inguinal hernia repairs are among the most common operations performed worldwide. An increasing number is performed minimally invasively with mesh placed pre-peritoneally. Some situations may require mesh removal. This can be complex and challenging. We share our technique to remove pre-peritoneal mesh using a minimally invasive approach.
Methods:
The multiple steps involved in robotic-assisted pre-peritoneal mesh removal are reviewed in detail, including preoperative planning, intraoperative positioning, review of anatomic landmarks, and systematic approach with technical tips to reduce complications.
Results:
We provide an attached narrated video guide with a written summary to outline pre-peritoneal inguinal mesh removal. The steps are applicable to both robotic-assisted and laparoscopic approaches. We present a video of the robotic-assisted approach. We prefer the robotic-assisted approach for most pre-peritoneal mesh removal based on results of our retrospective series of 26 patients undergoing 31 mesh removals. We noted that our robotic-assisted approach was more effective than the laparoscopic approach, with significantly less incidence of vascular injury (0 vs 5, p < 0.05) and less nerve (1 vs 4) and spermatic cord injuries (0 vs 1).
Conclusions:
As pre-peritoneal inguinal mesh implantation becomes more popular, surgeons may be seeing more patients with complications who may require mesh removal. We provide a detailed step-by-step approach with video to serve as a guide to surgeons who are planning for safe removal of pre-peritoneal inguinal hernia mesh.
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