Laparoscopic Management of Acutely Incarcerated Femoral Hernia

Abstract

Incarcerated femoral hernia is a common surgical emergency condition. Diagnosis is always obvious and straightforward by clinical examination, and open surgical repair is the mainstay of treatment. In the era of minimally invasive surgery, laparoscopic repair of femoral hernia has been shown to be feasible and safe. However, laparoscopic repair of acutely incarcerated femoral hernia has gained little discussion in the past. In this paper, we report the results of 8 consecutive cases of strangulated femoral hernia that was successfully managed by the laparoscopic approach.

Totally extra-peritoneal repair for acute incarcerated femoral hernia with intestinal obstruction

“…The turn of the century brought about the use of diagnostic laparoscopy to evaluate incarcerated groin hernias [9] . Soon after, reports of the use of TAPP [10] , [11] , [12] , [13] , [14] , [15] and TEP [16] , [17] , [18] , [19] , [20] , [21] in the repair of emergent groin hernias followed, with a systemic reviews showing encouraging operative times, hospital stay and morbidity [22] . Further reports demonstrated a reduction in laparotomy rates with less wound infection and shorter hospitalisation when comparing laparoscopic to open approaches [23] .…”

“…The reduction of hernia contents laparoscopically with TAPP or TEP can be challenging. The use of releasing incision to the constricting hernia neck has been well described [14] , [17] . For femoral hernias, a releasing incision medially in the lacunar ligament can help facilitate reduction.…”

Laparoscopic Total Extraperitoneal Repair in Femoral Hernia Without Fixation of the Mesh

“…12 Similar results have been reproduced for femoral hernias in laparoscopic total extraperitoneal (TEP) repair 16 and transabdominal preperitoneal repair (TAPP). 2,14,15 Laparoscopic surgery in all these studies was done with patients under general anesthesia (GA), and mesh fixation was done in most of them. As per our literature search, ours is the first study reporting laparoscopic femoral hernia repair with the patient under spinal anesthesia (SA) and without fixation of mesh.…”

“…Though conventionally, femoral hernia has been managed by open surgical methods, 1,4,10–13 of late laparoscopic management by transabdominal preperitoneal repair (TAPP) 2,14,15 and total extraperitoneal repair (TEP) 16 has become popular. The need to fix the mesh, requirements for general anesthesia, and the high cost are some the disadvantages of laparoscopic repair.…”

Laparoscopic transabdominal preperitoneal repair of strangulated femoral hernia: Superiority of an unusual emergency surgical approach due to a case

“…The risk of incarceration and strangulation of femoral hernias is high. Thus, intestinal resection is performed more frequently than other inguinal hernias [ 1 ]. Repair is more difficult than inguinal hernia because of deeper cavity where hernia occurs and proximity to the major vessels of legs, and the risk of reoccurrence is higher.…”