González ODL, Ramírez TAA, Balderrama BPC, Loya SA, Ojeda RMA

Language: Spanish
References: 11
Page: 182-188
PDF size: 1875.52 Kb.

ABSTRACT

Introduction: recurrent inguinal hernia in a previously operated and pelvic-irradiated surgical field represents one of the most technically challenging scenarios in laparoscopic surgery. Secondary fibrosis and obliteration of anatomical planes increase the risk of vasculoneural injury during dissection. Yellow enhancement (YE) is a digital image-processing modality integrated into nextgeneration laparoscopic platforms (Olympus VISERA ELITE III^®) that enhances tissue contrast without requiring exogenous contrast agents or additional hardware. Case presentation: a 64-year-old male presented with recurrent right inguinal hernia and inguinodynia. Relevant history included prior bilateral laparoscopic TAPP inguinal hernioplasty with polypropylene mesh and metallic tackers performed six years earlier, prostate adenocarcinoma treated with laparoscopic prostatectomy and 34 sessions of adjuvant pelvic radiotherapy. Intraoperative findings included dense fibrosis, extensive peritoneal adhesions, and partial obliteration of the Retzius space and the triangle of death. Systematic use of YE facilitated differentiation of fibrotic tissue, peritoneum, blood vessels, vas deferens, and the margins of the prior mesh, enabling safe dissection and successful TAPP repair with new mesh placement, without intraoperative complications. Conclusions: yellow enhancement is an accessible intraoperative visual enhancement tool, at no additional cost, that improves dissection safety in recurrent laparoscopic TAPP hernioplasty with a complex surgical field. Prospective studies are needed to determine its impact on clinical outcomes.

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