Appendix-Sparing Transabdominal Preperitoneal Laparoscopic Hernioplasty for a De Garengeot’s Hernia: Video Demonstration

Abstract

Background and Objectives: Less than 300 cases of a De Garengeot’s hernia have been published. This rare femoral hernia with the vermiform appendix included appears almost exclusively on the right side, mainly in females, and it generally debuts as an incarcerated femoral hernia. Although most of the times there is a concomitant appendicitis, clinical signs of peritonitis are absent. The wide use of radiologic exams has not favored its preoperative diagnosis, but been usually found incidentally during a surgical emergency. The best surgical approach to a De Garengeot’s hernia is not totally defined and many critical questions still remain unanswered. Open surgery is considered the standard treatment procedure, but since the emergence of laparoscopy for incarcerated hernias, this is certainly an option. Methods: We report the successful laparoscopic management of an 83-year-old woman who had been operated on her right inguinal hernia, with a Rutkow-Robbins’ technique, 4 months earlier. She had noticed the protrusion of a lump in her right inguinal region for 2 months. Radiological studies were not conclusive. With a miss diagnosis of a recurrent incarcerated inguinal hernia, a minimal invasive endoscopic approach was performed. A representative case of this fully laparoscopic TAPP procedure is presented. Results: The patient made an uninterrupted recovery. She left the hospital the day after in a stable condition and has enjoyed good health since. Conclusion: A fully laparoscopic TAPP approach seems perfectly safe and feasible to treat this entity, and could be considered the first line alternative when enough expertise is available.

Appendix-sparing laparoscopic transabdominal preperitoneal hernioplasty for a De Garengeot's hernia. A new case report and review of the literature

“…TAPP is commonplace today, becoming a routine procedure [ 21 , [23] , [24] , [25] ]. As Legnani et al [ 21 ] pointed out, this laparoscopic approach incorporates the advantages of a total abdominal overview and the observation “test time” of the repositioned appendix, which may improve management decisions.…”

“…The null infection rate reported in all the referred series [ [14] , [15] , [16] , [17] , [18] , [21] , [22] , [23] , [24] , [25] ], could be achieved thanks to the appendix preservation and the closure of the parietal peritoneum after the hernioplasty; thus, avoiding potential infections of the hernioplasty mesh.…”

“…Open surgery, with a simultaneous appendectomy and a primary hernia repair, is still considered the standard surgical treatment option, whatever the appendix condition. Since then, although unusual, a normal appendix in the femoral sac has been well documented in the literature many times [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ], but only a few cases of open surgery with preservation of the appendix have been published [ [14] , [15] , [16] , [17] , [18] ]. Since the emergence of laparoscopy for the treatment of incarcerated hernias [ 19 ], several papers have reported not only the successful minimally invasive management of this entity [ 20 ] but also the laparoscopic appendix-sparing of this condition, mainly after the coronavirus disease (COVID-19) pandemic [ [21] , [22] , [23] , [24] , [25] ].…”