Laparoscopic Repair of a Sciatic Hernia Using a Self-Fixating Mesh: A Case Report

INTRODUCTION: A hernia that protrudes through the sciatic foramen is called a sciatic hernia and is classified as a pelvic hernia, although it is the rarest type. We aimed to report a case of elective laparoscopic repair of a sciatic hernia using a self-fixating mesh. CASE PRESENTATION: The patient was a 78-year-old female who had experienced intermittent numbness in the right thigh for approximately 1 year. Whole-body CT performed during hospitalization for pneumonia revealed small-bowel herniation through the right sciatic foramen. MRI showed the small-bowel protruding above the sacrospinous ligament, confirming diagnosis of a right greater sciatic foramen hernia. Her thigh numbness was attributed to the hernia, and because she had no signs of bowel obstruction or ischemia, elective surgery was planned after pneumonia treatment. Laparoscopic repair involved dissecting the preperitoneal space around the sciatic foramen and placing a self-fixating mesh. CONCLUSIONS: We ensured a safe operative field and performed careful dissection and non-fixation mesh placement while preserving the vessels, nerves, and ureter around the sciatic foramen, resulting in an uneventful postoperative course. Reports of laparoscopic mesh repair for sciatic hernia remain limited. Based on previously prior cases, we discuss mesh selection, the need for mesh fixation, and the optimal extent of dissection required for placing a sheet-type mesh.