Laparoscopic Transabdominal Preperitoneal (TAPP) Hernioplasty with Overlapping Mesh Technique for Large Direct Inguinal Hernia in an Elderly Patient with Prior Contralateral TEP Repair: A Case Report

Abstract: Background: Managing large direct inguinal hernias in elderly patients with a history of prior transabdominal preperitoneal (TEP) repair on the contralateral side presents a significant surgical challenge due to severe fibrosis and anatomical distortion within the Retzius space. Case Presentation: We report the case of an 86-year-old male presenting with a large left direct inguinal hernia (defect >3 cm) containing small bowel, colon, and omentum. The patient had a previous contralateral TEP hernia repair six years prior. A transabdominal preperitoneal (TAPP) approach was utilized, involving meticulous adhesiolysis of the retro-pubic space followed by the placement of overlapping 10x15 cm polypropylene meshes to reinforce the myopectineal orifice, supplemented by prophylactic preperitoneal drainage. The operative time was 132 minutes, with successful reduction of the hernia sac and preservation of vascular structures. Postoperatively, the patient’s comorbidities-hypertension and type 2 diabetes—were strictly managed. The patient experienced an uneventful recovery with no signs of seroma, hematoma, or surgical site infection, and was discharged on postoperative day 7. Conclusion: TAPP combined with an overlapping mesh technique represents a effective solution for complex, large direct inguinal hernias in elderly patients with a history of prior contralateral preperitoneal surgery. This approach provides an enhanced visualization for navigating distorted anatomical planes and ensures robust abdominal wall reconstruction. Keywords: Direct inguinal hernia, TAPP, TEP, overlapping mesh, elderly.