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

Abstract

IntroductionInguinal hernia repair is one of the most common operations of general surgery. In order to avoid complicated and urgent cases, performing such operations electively is generally accepted. Otherwise, unforeseen emergency surgical situations accompanied by incarceration and strangulation may occur.Case presentationIn this article, we present a 45-year-old female patient with strangulated femoral hernia repair that we performed using the laparoscopic transabdominal preperitoneal method, unlike other conventional methods.DiscussionEarly diagnosis and elective surgical treatment have an important role in hernia surgery, especially due to increased morbidity and mortality. Laparoscopic inguinal hernia repair has developed in the recent years as a prominent method and nowadays it is performed much easier than the open method even in urgent and challenging cases.ConclusionThe transabdominal preperitoneal method has superiority over the conventional method in terms of ensuring that intestinal loop is visible during the strangulated femoral hernia repair and that the feeding of the intestine is intact.

Laparoscopic approach as a safe and effective option for incarcerated femoral hernias

“…These patients underwent laparoscopic surgery for incarcerated femoral hernia (Table 2). [9][10][11][12][13][14][15][16][17][18][19] While the traction method seems to be the most popular method, preperitoneal method was performed in three patients. It should also be noted that bowel resections were rarely performed in these patients.…”

TAPP laparoscopic inguinal hernia repair associated with intestinal resection to solve a Richter's hernia

“…Por su baja frecuencia generalmente se diagnostica en presencia de obstrucción intestinal o complicaciones graves como la perforación intestinal 3 . Debido a lo anterior, se requiere de una adecuada sospecha diagnóstica asociada a un tratamiento oportuno para evitar complicaciones mayores 4 .…”

“…Entre los factores que se asocian a complicaciones posoperatorias y elevada mortalidad se encuentran la presencia de hernia por tiempo prolongado y la irreductibilidad, el retraso en la admisión hospitalaria y la presencia de comorbilidades 4 .…”

“…Se describen dificultades técnicas asociadas a la reducción del saco herniario y su contenido al abdomen, así como un incremento en el riesgo de lesión a otros órganos durante el procedimiento. Por otro lado, la visualización directa del órgano incarcerado o estrangulado y la posibilidad de una resección intestinal laparoscópica o extracorpórea, asociada a la plastia inguinal, ofrecen ventajas significativas 4,8 .…”

“…Es una entidad poco frecuente y representa únicamente el 1 % de las hernias de pared abdominal; generalmente se diagnostica cuando se asocia a una obstrucción intestinal 3 . Se requiere de una adecuada sospecha diagnóstica asociada a un tratamiento oportuno para evitar complicaciones mayores 4 .…”