Robotic-Assisted Transabdominal Preperitoneal (rTAPP) Femoral Hernia Repair
Katie A. Marrero, MD1; Eric M. Pauli, MD, FACS, FASGE, FEBSAWS (Hon.)2
1Henderson Hospital, NV
2Penn State Health Milton S. Hershey Medical Center
Femoral hernias are an uncommon cause of groin pain but occur more frequently in women than men and are often overlooked during clinical evaluation and imaging review. Failure to recognize these “hidden” hernias may lead to persistent symptoms despite previous inguinal hernia repair.
A 43-year-old woman presented with chronic left groin pain despite prior open left inguinal hernia repair with mesh plug placement. Her medical history included cesarean section and abdominoplasty, with pain initially attributed to postoperative nerve injury. A CT scan obtained in 2023 was interpreted as negative for recurrent hernia; however, retrospective review demonstrated an obvious left femoral hernia adjacent to the previously placed mesh plug. She subsequently underwent treatment for May-Thurner syndrome with left common iliac vein stenting without improvement in symptoms. Clinical examination, office ultrasound, and re-evaluation of prior imaging confirmed the diagnosis of a symptomatic femoral hernia.
A robotic transabdominal preperitoneal (rTAPP) repair was performed. After establishing abdominal access and creating a generous preperitoneal flap, the myopectineal orifice was completely exposed. The previously placed mesh plug was identified medial to the inferior epigastric vessels and largely left undisturbed with only a small portion excised to facilitate flat placement of new mesh. The femoral hernia sac and incarcerated preperitoneal fat were reduced, the round ligament was divided, a large preperitoneal mesh was positioned to cover the femoral canal and all potential groin defects, and the peritoneal flap was closed.
This case demonstrates the importance of maintaining a high index of suspicion for occult femoral hernias in women with persistent groin pain, particularly following previous anterior inguinal hernia repair. Robotic TAPP repair provides excellent visualization of the entire myopectineal orifice and enables definitive treatment while preserving previously implanted mesh when appropriate.