Laparoscopic approach to incarcerated inguinal hernia

Abstract

The safety and effectiveness of laparoscopic treatment for incarcerated inguinal hernia have not been clarified. Six patients who underwent laparoscopic reduction and repair of incarcerated inguinal hernias were reviewed retrospectively. All operations were initiated within 1 h after establishment of the diagnosis. Laparoscopically, the incarcerated small-bowel segments could be easily returned to the abdominal cavity by a combination of pulling them with Babcock forceps while pushing back the bowels from outside the abdominal wall. The hernial portals were not cut in three patients, while they were dissected in the other three. All incarcerated bowels were congested and red immediately after reduction; however, their color returned to normal during hernia repair and unnecessary bowel resection was therefore avoided. The mean operation time was 88 min. Although one patient underwent laparotomy because of the suspicion of necrosis of the incarcerated inguinal hernia, which was finally found to be due to postoperative paralytic ileus, the postoperative courses of the remaining five were uneventful. Laparoscopic reduction and repair of incarcerated inguinal hernia was useful, and unnecessary bowel resection could be avoided.

Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia

“…Traditionally, incarcerated inguinal hernia, whether acute or chronic, has been treated with conventional techniques [8]. The first successful laparoscopic treatment, which was combined with a laparoscopically assisted intestinal resection, was reported in 1993 [27].…”

“…Most articles in the literature have reported on the TAPP approach [4,12,14]. Ishihara et al [8] wrote that in their study all incarcerated bowels were congested and red immediately after reduction, but that their color returned to normal during hernia repair, and unnecessary bowel resection could thereby be avoided.…”

“…Incarcerated hernia has been among the last of the hernia types to be treated laparoscopically. The procedure still is controversial, and may be contraindicated in some cases [20], but successful reduction and repair have been reported for nonacutely incarcerated inguinal hernia [5,8,14]. Of the few studies available, most involve use of the transabdominal approach (TAPP) [5,12,14,27].…”

The combined laparoscopic approach for the treatment of incarcerated inguinal hernia

“…Initially, the transabdominal preperitoneal (TAPP) approach was more commonly used for reduction and repair of the incarcerated hernia [5,6]. Recently, a number of series have used the total extraperitoneal (TEP) approach as an option [7][8][9][10].…”

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

“…It reviews seven articles on this topic, dating from 1989 to 2008, reporting on 328 cases treated with total extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) repair. Of these seven articles, two are LE 2b prospective cohort studies and five are LE 4 small case series [271][272][273][274][275][276][277]. The overall results of the Deeba et al study were that average operative time was 61.3 min, average hospital stay was 3.8 days, mortality rate was 0.28 %, complication rate was 10.3 %, conversion rate was 1.8 %, intestinal laparoscopic or minilaparotomy resection rate was 5.1 %, and reoperation rate was 0.9 %.…”