Mesh repair of sacrococcygeal hernia via a combined laparoscopic and sacrococcygeal approach: A case report

Figure 1 Preoperative physical examination. A bulge in the right sacrococcygeal region, which was approximately 8 cm × 8 cm in size and soft in palpation with no tenderness, was revealed upon standing.

Figure 2 Computed tomography image. Computed tomography revealed rectal herniation and an abnormality in the structure of the tissues between the sacrococcyx (arrow) and the right gluteus muscle.

Figure 3 Laparoscopic findings. In the right anterior sacrococcygeal region, a defect approximately 6 cm × 6 cm in size was identified, through which part of the rectum protruded.

Figure 4 Sacrococcygeal findings. The hernia defect was visualized after opening the hernia sac.

Figure 5 Mesh placement via the sacrococcygeal approach. A properly sized self-gripping polyester mesh was placed deep into the defect and intermittently sutured to the edges.

Figure 6 Mesh accommodation under laparoscopy. The implanted mesh was inspected for accommodation in a good location.

Figure 7 Postoperative physical examination. At the time of discharge, no relapsing bulge was found when performing the Valsalva manoeuvre.

Figure 8 Diagram of the anatomy of the repair. Line A is the surgical plane for laparoscopic approach, and it is posterior to the mesorectum; line B is the surgical path for sacrococcygeal approach, and it extends through the skin and subcutaneous fat to the level of the defect, and allows the placement of the mesh (blue arrow).