Inguinal hernia repair after ilio-iliac artery bypass

Inguinal hernia after lower limb artery bypass surgery using the external iliac artery is particularly rare with no standard operation method. An 81-year-old man with a history of ilio-iliac artery bypass was diagnosed with right inguinal hernia. Given that no dissection was necessary in the preperitoneal space around the external iliac artery, which was anastomosed with an artificial vessel graft, and that the procedures could be performed above the transverse abdominis, the Lichtenstein method was selected for the case. This intervention demonstrated technical challenges in creating the space for mesh placement under the artificial vessel graft. During the procedure, the artificial vessel graft and posterior wall of the inguinal canal required careful dissection due to the adhesion of these structures. The case outcome was favorable.