Two Cases of Inguinal Hernia after Kidney Transplantation Treated with Transabdominal Preperitoneal

The Lichtenstein procedure is often selected for kidney transplantation (KT) recipients due to concerns about the risk of injury to the transplanted organ. However, there have been reports of complications such as ureteral obstruction in cases where the Lichtenstein procedure was performed; therefore, safer techniques and approaches must be selected. We herein report 2 cases of inguinal hernia on the transplant side after KT that were treated with laparoscopic hernia repair (transabdominal preperitoneal [TAPP]) following a careful preoperative assessment.

The first case was a 55-year-old man who had undergone KT 9 months earlier and developed a bulge in the right inguinal region 3 months prior to presentation. Contrast-enhanced CT was used to assess the ureteral course, and the extent of TAPP dissection was determined. Intraoperative findings revealed a direct hernia. Dissection was performed while confirming the ureteral course, and TAPP repair was completed. Postoperatively, the patient's condition progressed uneventfully without recurrence at 21 months. The second case was a 58-year-old woman who had undergone KT 1 year earlier and subsequently developed swelling in the right inguinal region. Due to deterioration of the kidney function, enhanced CT was to be avoided. Plain CT was thus performed, but the evaluation of the transplanted ureter course was difficult. Laparoscopic observation was performed to evaluate the location of the transplanted ureter and kidney. A direct hernia was recognized. After determining the dissection of exposure of the myopectineal orifice and mesh deployment, TAPP repair was performed completely. Postoperatively, the patient's condition progressed uneventfully without recurrence at 14 months.

A preoperative evaluation of the transplanted kidney and ureter using CT is an important surgical strategy for KT patients with groin hernias. The TAPP procedure is appropriate because it allows safe visualization of the hernia type and the transplanted ureter from the abdominal cavity and enables dissection. TAPP was considered the most appropriate surgical procedure when an adequate distance between the hernial orifice and transplanted ureter could be confirmed.