There could be various reasons for this.

1. Damage to the urinary bladder.

2. Damage to the vascular structures leading to a hematoma.

3. Parietal wall hematoma.

These need to be considered.

hi you all

i think a vascular issue (epigastric vessel lesion).  

Maybe a bladder lesion as well (do we know if she was managed with a urinary catheter when incontinence was diagnosed?)  Sometimes while dissecting the medial aspect of the inguinal area, for Cooper´s Ligament exposure, antero-superior bladder dissection might happen.  In pelvic surgery, the placement of a urinary catheter will add a continuous bladder decompression; hence less chances of bladder injury.

I am not sure what to make out of the digestive symptoms.  Some patients might develop a peritoneal chronic inflammatory response.  Some might have seromas, some might develop intestinal adhesions.   Totally Extraperitoneal Hernia Repair does not prevent intestinal adhesion formation; it is associated with a lesser incidence of them.  In this particular case, the vascular lesion and the probable bladder lesion impose a higher risk of inflammatory response.

As any other incision, the exposure of blood or inflammatory fluids or infection, may contribute in postincisional hernia formation.  Trocar sites behave as any other surgical incision.  Question:  what size were the trocars used?  all trocars larger then 5mm should be sutures including the aponeurosis.  Failure to do so is associated with a higher incidence of trocar site postincisional hernia.

Let us know how things come along.

Take care

i think it is combined urinary bladder and inferior epigastris srtery injury

Hi you all,

First of all in my opinion laparoscopic approach for an inguinal hernia in women is not the best choice. But it doesn't matter. I think that you have a large retrorectus haematoma from an epigastric pedicle injury. This collection can mimic an acute abdomen and the related digestive symptoms. Probably was a quite important bleeding because BP in the first postop day was small enough. Concerning urinary incontinence and hematuria probably was the consequence of an inadvertent dissection in the space of Retzius. I wish you all tyhe best

I cannot thank you enough for your information. I have the DVD of the internal operation but do not know how to put it on this site (even if it is possible). I showed the surgeon the photos which he dismissed and said "well you signed the consent form". I  sincerely thank you.

Postoperative complication could be various reasons;

1.Damage to the urinary bladder.

2. Damage to the vascular structures leading to scrotal hematoma,seroma and scrotal edema

3.Wound infection.

4.Damage to the bowel.

It appears that the surgeon has caused injury to the interior epigastric vessels y dissecting too close to the rectus muscles in the lower midline. A higher injury would have been detected and corrected per op. Secondly there has been a bladder injury too perhaps during the medial dissection looking for direct defect-----unusual in female patients with inguinal hernia---- right below the Cooper's ligament.

It is unlikely that there has been a bowel injury. The symptoms are explained by retro-rectal haematoma. The delayed bulge us due to the resulting fibrosis of the rectus healing phase. Appropriate exercises should get her back to normal. If there is sport site bulge then it should be treated as an incisions hernia.

Important to stay in the RIGHT plane during TEP dissection 

I question the use of laparoscopic procedure for small hernias which can easily done using open mini-incisions 

Thank you for your very helpful comments. I would be most interested to know more about open mini-incision techniques.

Please see my website for details - I use the lightweight dual layered ultra pro mesh (UHS @ ethicon) which can be inserted through small incisions even for large hernia as a plug and patch hernia system

Dhiren Nehra: Home

www.mrdnehrafrcs.com

Mobile-friendly - He has developed his own technique for mini-incision inguinal hernia repair and incisional hernia repair. He has been ...

For a woman with a 21 bmi the open repair of a small inguinal hernia  can be easily done with a 4 cm incision. Usually the mesh is not rewuired if the hernia is indirect. Of you want a mesh repair a flat light or ultralight macroporous polypropylene mesh is the best option. I don.t remember if the surgeon extract y our mesh after the first repair. I don.t received the movie of y our surgery yet

I have re-sent the video into your email address. I wonder if it could have gone in your junk mail (these computers have a mind of their own) I had to get a friend to do this for me as it is beyond my IT skills. I keep trying. Thank you for your patience.

I have my TEP repair on this link. https://youtu.be/DgqdWBDtg20. I would be most grateful for any comments/observations or information. Thank you

Hi.

Performing a TEP in a female patient is according to the Guideline of European Hernia Society absolutely correct. The procedure has been done with some technical diffulculty but alright. Although I wouldn't leave the Op-situs that bloody back.

Seeing the Op-Video no one would wonder that postoperatively the patient gets such hematomas/suffusions. All these can explain the postoperativ discomfort / pain which sometimes can take several weeks time!

There shouldn't be a direct correlation between the urinary incontinenz and the TEP-procedure as far as I can see on the video. 

The epigastric lump (propably a epigastric hernia ) may has been already there preoperatively. Otherwise it could be a postoperativ seroma which is very unsual at this position.

Where are the other hernia which were diagnosed by ultrasound postoperatively?

If at the right groin, it would mean that there is an early recurrent hernia after a technical/operative failure. 

Many thanks. The epigastric hernia was definitely not there before the op. There was subcutaneous emphysema with it, it was extremely painful. The other 2 hernias are below the epigastric hernia.  I had a 5 cm umbilical incision that went right into the centre of the umbilicus. The umbilicus is still painful one year after the op, as is the epigastric hernia. I am still getting pain in the right groin, the operation site is still painful.