Behind the knife

Chronic groin pain after inguinal hernia repair is an unfortunate outcome for patient. In a minority of cases, mesh explantation is indicated. This video reviews a bilateral mesh explantation and highlights strategies for piecemeal removal of mesh, use of a 3rd accessory arm, and management of the peritoneal flap. The mesh explanation on the right primarily aimed to resolve groin and lower abdominal pain, likely related to penetrating fixation of mesh. The left sided explantation was performed for testicular and lateral thigh pain, likely a result of nerve entrapment from a malpositioned mesh that had been placed between the cord elements and the abdominal sidewall. The patient's symptoms dramatically improved after the operation.