A laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia is being performed. The surgeon encounters a lipoma of the cord. What is the correct management of a cord lipoma during TEP repair?

• A Reduce or excise the lipoma, as it occupies the deep inguinal ring and may predispose to recurrence if left ✓
• B Leave it in situ as it does not contribute to the hernia
• C Convert to open repair as lipomas are best managed by open dissection
• D Place the mesh over the lipoma without reduction

Explanation

A cord lipoma (retroperitoneal fat that herniates through the deep inguinal ring into the cord) is found in up to 22% of laparoscopic hernia repairs. It must be reduced back to or excised from the preperitoneal space, as it occupies the deep ring and failure to address it is associated with pseudo-recurrence (the persistent lump simulates recurrent hernia) and true recurrence by maintaining a patent ring that the mesh must cover. After cord lipoma reduction, the mesh (typically 10x15 cm) adequately covers the myopectineal orifice including the direct, indirect, and femoral spaces.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.