A giant inguinal hernia in a patient with Ehlers-Danlos syndrome Ann Ital Chir - 2021, 10 - Febb. 5 - Online Epub 1 Ann Ital Chir, 2021; 10 - Febb. 5 pii: S2239253X21034770 Online Epub Pervenuto in Redazione Settembre 2020. Accetato per la pubblicazione Novembre 2020 Correspondence to: Prof. Gennaro Quarto, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131, Naples, Italy (e-mail: gquarto@unina.it) Gennaro Quarto, Anna D’Amore, Sara Vertaldi, Pietro Anoldo, Giacomo Benassai, Giovanni Domenico De Palma, Michele Manigrasso, Marco Milone Department of Clinical Medicine and Surgery, University “Federico II” of Naples, Naples, Italy A giant inguinal hernia in a patient with Ehlers-Danlos syndrome. BACKGROUND: Inguinal hernia formation is a common event in patients with Ehlers-Danlos syndrome. Minimally inva- sive surgical technique for inguinal hernia repair is the same used in patients without EDS but it is related to more intraoperative and postoperative complications. AIM: Inour study, we present a case of inguinal hernia in a EDS patient successfully treated with a robotic transab- dominal preperitoneal procedure (TAPP procedure). MATERIAL AND METHODS: We decided to perform a robotic TAPP with the DaVinci Xi® platform (Intuitive Surgical, Sunnyvale, USA) under general anaesthesia. A robotic docking was performed and three arms were positioned in the abdomen. Total operative timing was 45 mins. RESULTS: During the robotic procedure no intraoperative complications were recorded and no drains were applied. Te postoperative period was uneventful and the patient was discharged in the frst postoperative day. DISCUSSION: Inguinal hernia occurs more frequently in patients with EDS, mainly men. Many surgeons believe that EDS may have a negative efect on the clinical outcome of hernioplasty because of postoperative complication and recur- rence rates. Our strategy has been robotic technology to facilitate the surgical approach. CONCLUSION: Robotic technology is feasible and associated with a shorted recovery and better cosmetic results. Te endowrist movement of the robotic arms allows wide instrument articulation in a confned space, bypassing the limitis of laparoscopic instruments. In this way, it is possible to realize an accurate dissection of important elements, to reduce operative timing and intraoperative and postoperative complications. KEY WORDS: Ehlers-Danlos syndrome, Inguinal hernia, TAPP In our study, we present a case of inguinal hernia in a EDS patient treated successfully with a robotic transab- dominal preperitoneal procedure (TAPP procedure). Case Presentation A 61-year old male with EDS presents a left inguinal hernia since six years. His skin has been elastic since infancy and he has been able to hyperextend it. His joints has shown more than the normal range of move- ment since babyhood. Furthermore, he sufers from heart failure, coronary artery disease, varicose veins, hyperten- sion, hypercholesterolemia and diabetes mellitus. Te patient previously underwent stripping of varicose veins of the lower limbs, according to current literature 1 . Background Inguinal hernia formation is a common event in patients with Ehlers-Danlos syndrome, mainly in men. Minimally invasive approach to inguinal hernia repair is the same used in patients without EDS but it is relat- ed to more intraoperative and postoperative complica- tions. Digital Edition e-publish on-line ISSN 2239-253X Direttore Nicola Picardi READ-ONLY COPY PRINTING PROHIBITED