Simultaneous Laparoscopic Femoral Hernia Repair and Retropubic Mid-Urethral Sling Placement in Female Patient with Stress Urinary Incontinence and Symptomatic Femoral Hernia

Abstract

Introduction:

Inguinal hernias are far less common in women compared to men, affecting <2%, which has meant surgical approaches and outcomes are understudied in women. Urinary incontinence is a common condition in women, with a prevalence that increases with age, from 28% for 30–39-year-old women to 55% for 80–90-year-old women. Women presenting for inguinal hernia repair evaluation may have concomitant urinary incontinence; however, guidance on the best approach for surgical management of both conditions is lacking. In particular, concerns related to performing the procedures simultaneously centers on the increased risk of infection associated with the clean-contaminated nature of vaginal surgery in the setting of permanent mesh use for inguinal hernia repairs. There are no case reports or series evaluating this subset of patients to help guide multidisciplinary care decisions. This video illustrates the case of a 49-year-old female with left-sided femoral hernia and stress urinary incontinence (SUI) who underwent a simultaneous laparoscopic femoral hernia repair and retropubic mid-urethral sling placement after multi-disciplinary evaluation.

Materials and Methods:

The video was recorded in high definition using the standard laparoscopic tower video capture system at our institution. All patient identifiers were removed prior to video editing. Two grams of cefazolin were administered for preoperative antibiotics prior to the start of the procedure. The patient was positioned in low lithotomy and the abdomen was prepped in a sterile fashion. Urogynecology team started with the vaginal dissection. The abdomen was entered using Hasson technique and the remaining trocars were placed in the usual position under direct visualization. Next, the peritoneal flap was created, and the femoral hernia sac was identified and reduced. Betadine was applied to the plastic covering of the sling. Urogynecology then placed the retropubic midurethral sling by passing the trocars through the suprapubic incisions until the sling was appropriately positioned vaginally. Next, a polypropylene mid-weight inguinal mesh was placed, and the peritoneal flap was closed.

Results:

The patient was discharged on postoperative day 0. At the 6-week follow-up, patient reported no groin symptoms and improved urinary incontinence. There was no evidence of hernia recurrence or infection at follow-up. Success after SUI surgery ranges from “dry,” “satisfied,” or “much improved.” Patients are considered fully healed from surgery within 6 weeks and may resume normal activity.

Conclusion:

We demonstrated a successful combination of laparoscopic inguinal hernia repair and retropubic midurethral sling for a woman with symptomatic inguinal hernia and SUI with resolution of inguinal hernia symptoms as well as subjective urinary incontinence symptom improvement. Recognition of pelvic conditions in women with inguinal hernias allows multidisciplinary collaboration and may benefit patients. Although the benefits of this approach for this patient were clear and there were no infection complications, the transformation of the hernia repair from a clean case to a clean-contaminated case did increase infection risk. Further evaluation of outcomes of combining these approaches in a larger series of patients is warranted since preforming either operation after the previous operation has been performed is more challenging.

Consent:

The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Sources of work and conflict of interest:

This work was performed at Unity Point Health Meriter Hospital. The authors report no conflict of interest or obligations related to this work.

Author disclosure statement:

The authors have no commercial associations during the last 3 years that might create a conflict of interest in connection with the video.

Previously presented at 2025 SAGES Annual Meeting and the Wisconsin Surgical Society 2025 Annual Conference.

Runtime of video: 7 min 52 sec.