Missed lipoma of the spermatic cord - A pitfall of transabdominal preperitoneal laparoscopic hernia repair

Background: Missed lipoma of the spermatic cord is a pitfall unique to the transabdominal preperitoneal (TAPP) laparoscopic hernia repair. This proble m occurs when a palpable inguinal mass is noted preoperatively, but no iden tifiable hernia defect is found at time of laparoscopy and the procedure is terminated. Methods: Our group encountered six patients without intraperitoneal defects that had large cord lipomas on preperitoneal exploration. Two of these pat ients had undergone previous intraabdominal laparoscopy for a proposed TAPP repair, which was aborted when no defect was seen. Results: Both patients were referred for continued symptomatic groin masses , which were subsequently treated by lipoma resection in conjunction with i nguinal floor repair. Conclusions: When patients present with a groin mass, exploration of the pr eperitoneal space and cord structures is indicated during TAPP repair, even in the presence of a normal-appearing abdominal floor. Abandoning a transa bdominal approach without exploration of the preperitoneal structures may l ead to a failure to identify symptomatic and/or palpable cord lipomas.