Background: Laparoscopic exploration of the contralateral side during inguinal herniorrhaphy in
infants is becoming popular. We present an unusual complication of this technique, namely forceful
evacuation of retained pneumoperitoneum mimicking an acute recurrent hernia.
Methods: A 9-month-old female presented for right inguinal herniorrhaphy. Laparoscopic exploration
of the left side revealed a closed left internal ring. The pneumoperitoneum was evacuated.
The hernia sac had started to tear so it was closed with a running horizontal mattress suture instead
of a double ligature after twisting. The internal ring was closed. Upon emergence from anesthesia,
the right groin was filled with a mass that we felt was subcutaneous emphysema from evacuation
of residual pneumoperitoneum. But to rule out an acute recurrent hernia, we re-explored
the groin. There was a large collection of air that had dissected in the subcutaneous tissues and under
Scarpa's fascia. The hernia repair was intact. Follow-up 6 months after the repair showed no
evidence of a recurrence.
Results: This is the first report of an unusual complication of laparoscopic exploration of the contralateral
side during hernia repair. Two factors contributed to it. The sac closure was a running
mattress suture, which is not as airtight as a double ligature after twisting. The second is the incomplete
evacuation of the pneumoperitoneum.
Conclusion: With the increasing use of laparoscopic contralateral exploration, this case illustrates
the need to evacuate the pneumoperitoneum as thoroughly as possible and to consider an airtight
closure of the sac.
