This video demonstrates Right-Sided IPOM Inguinal Hernia Repair with Left-Sided Varicocelectomy performed by Dr. R K Mishra at World Laparoscopy Hospital. Laparoscopic IPOM repair for inguinal hernia is a standard procedure but is occasionally performed in patients who are good candidates for the repair of intraperitoneal Onlay mesh repair due to a peritoneal defect of small size or the presence of a fibrotic and scarred preperitoneal cavity. 

What is IPOM hernia repair?

The IPOM (Intraperitoneal Onlay Mesh) technique is a special repair procedure where a mesh is introduced into the abdominal cavity and placed from the inside over the hernia opening. To conduct this endoscopic IPOM technique, a small incision is first made in the scar-free abdominal wall.

Laparoscopic varicocelectomy is efficient in the treatment of symptomatic varicoceles with a low complication rate. However, careful patient selection is necessary because it appears that individuals presenting with sharp, radiating testicular pain and/or a low-grade varicocele are less likely to benefit from this procedure. Laparoscopic varicocelectomy is a valid therapeutic approach to improve semen parameters for further assisted reproductive techniques. Spermatogenesis may be induced in patients with NOA. Normalization of semen parameters can be achieved for patients with OAT.

Performing a Right-Sided IPOM (Intraperitoneal Onlay Mesh) Inguinal Hernia Repair alongside a Left-Sided Varicocelectomy is a classic example of "multisurgical" efficiency. At World Laparoscopy Hospital (WLH), this combined approach allows a patient to address both a structural defect (hernia) and a vascular issue (varicocele) in a single 60-minute session.

Under the training protocols of Dr. R.K. Mishra, this procedure emphasizes the use of minimal ports to treat two different anatomical regions.

1. Right-Sided IPOM Inguinal Hernia Repair

While TAPP and TEP are common for inguinal hernias, the IPOM (Intraperitoneal Onlay Mesh) technique is a streamlined approach often used when the surgeon is already working within the peritoneal cavity.

• The Defect: A "middle-sized" hernia means the sac is large enough to cause discomfort but hasn't yet caused bowel incarceration.

• The Procedure: * The contents of the hernia sac (usually omentum or bowel) are reduced back into the abdomen using gentle traction.

  • The Mesh: A specialized "dual-layer" or "composite" mesh is used. One side is designed to incorporate into the abdominal wall, while the other side is "non-adherent" to prevent the intestines from sticking to it.

  • Fixation: The mesh is secured over the right inguinal canal using absorbable tackers or Mishra’s intracorporeal suturing.

2. Left-Sided Varicocelectomy

Simultaneously, the surgeon addresses the dilated veins in the left scrotum (varicocele), which can cause pain or infertility.

• The Target: The internal spermatic (gonadal) veins.

• The Technique:

  • The surgeon identifies the left gonadal vessels as they cross the psoas muscle.

  • Identification of the Artery: Extreme care is taken to separate the spermatic artery and lymphatics from the veins. Preserving the artery is vital for testicular health.

  • Ligation: The dilated veins are clipped and divided or ligated using Mishra’s Knot. By ligating these veins, the "backflow" of blood is stopped, resolving the varicocele.

3. The WLH Surgical Strategy: Ergonomics and Access

Performing surgery on both the right and left sides requires strategic port placement to avoid "sword fighting" (instruments hitting each other).

Step	Detail
Port Placement	A 10 mm umbilical port (camera) and two 5 mm working ports (lateral). This "diamond" or "triangulation" allows access to both inguinal regions.
Anesthesia	General anesthesia with a "TAP Block" for superior post-operative pain control.
Instruments	Use of Maryland dissecting forceps and fine bipolar cautery to ensure bloodless dissection.

4. Why Combine These Procedures at World Laparoscopy Hospital?

1. Shared Port Sites: The same three incisions used for the hernia repair are used for the varicocelectomy. No extra cuts are required.

2. Single Recovery: The patient recovers from both conditions simultaneously.

3. Cost-Effectiveness: Reduces hospital stay, pharmacy costs, and total surgical fees compared to two separate operations.

4. Expertise in Suturing: WLH trainees utilize advanced suturing techniques to fix the mesh, which can reduce the "nerve entrapment" pain sometimes associated with mechanical tackers.

5. Recovery Timeline

• Day 1: Patient is typically ambulatory (walking) within 6 hours and discharged the same day or the following morning.

• Day 3-5: Return to sedentary work.

• Week 2: Scrotal swelling from the varicocelectomy typically subsides.

• Week 4: Full return to heavy lifting or strenuous exercise (once the hernia mesh is fully integrated).

Conclusion

The combination of a Right IPOM and Left Varicocelectomy at World Laparoscopy Hospital represents the pinnacle of Minimal Access Surgery. By using the same optical view to treat different quadrants, surgeons provide a comprehensive solution that is safer and more convenient for the patient.

For more information:

World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA : +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE : +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA : +1 321 250 7653