Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia

G. Ferzli, Kenneth Shapiro, G. Chaudry, S. Patel

Research output: Contribution to journalReview article

57 Citations (Scopus)

Abstract

Background: Laparoscopic treatment of acutely incarcerated inguinal hernia is uncommon and still controversial. Those being performed almost all use the transabdominal (TAPP) approach. The authors here present their experience with totally extraperitoneal (TEP) repair of acutely incarcerated hernia. Methods: A retrospective review was undertaken to evaluate the authors' experience with this procedure over a 4-year period. There were 16 cases, 5 of which were performed using a conventional anterior repair. These 5 cases were excluded from the review. The surgery for all of the remaining 11 acutely incarcerated hernias was started laparoscopically using the TEP approach. Eight of the cases were completed this way, whereas three were converted to the open procedure. In addition to standard TEP repair techniques, a releasing incision is required for acutely incarcerated direct, indirect, or femoral hernias. With a direct hernia, the opening of the defect is enlarged to allow safe dissection of its contents. A releasing incision is made at the anteromedial aspect of the defect to avoid injury to the epigastric or iliac vessels. With an indirect hernia, several additional steps are required. The epigastric vessels may be divided; an additional trocar may be placed laterally below the linea semicircularis to facilitate dissection of the sac and to assist with suturing of the divided sac; and the deep internal ring is divided anteriorly at the 12 o'clock position toward the external ring, facilitating dissection of the indirect sac. With a femoral hernia, a releasing incision is made by carefully incising the insertion of the iliopubic tract into Cooper's ligament at the medial portion of the femoral ring. Results: The mean operative time was 50 min (range, 20-120 min), and the length of hospital stay was 5.4 days (range, 1-29 days). During a follow-up period of 9 to 69 months, there was no recurrence, and only two complications. One of these complications was an infected mesh that occurred in a case involving cecal injury. It was treated with continuous irrigation and salvaged. The other complication was a midline wound infection after a small bowel resection for a strangulated obturator hernia. Conclusions: Familiarity with the anatomy involved leads to the conclusion that the laparoscopic approach, specifically the TEP procedure, can be used without hesitation even in cases of acutely incarcerated hernia.

Original languageEnglish (US)
Pages (from-to)228-231
Number of pages4
JournalSurgical Endoscopy and Other Interventional Techniques
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2004
Externally publishedYes

Fingerprint

Inguinal Hernia
Hernia
Femoral Hernia
Dissection
Length of Stay
Obturator Hernia
Wounds and Injuries
Wound Infection
Operative Time
Thigh
Ligaments
Surgical Instruments
Anatomy
Recurrence

Keywords

  • Incarcerated
  • Inguinal hernia
  • Laparoscopy
  • TEP

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia. / Ferzli, G.; Shapiro, Kenneth; Chaudry, G.; Patel, S.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 18, No. 2, 01.02.2004, p. 228-231.

Research output: Contribution to journalReview article

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AU - Ferzli, G.

AU - Shapiro, Kenneth

AU - Chaudry, G.

AU - Patel, S.

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N2 - Background: Laparoscopic treatment of acutely incarcerated inguinal hernia is uncommon and still controversial. Those being performed almost all use the transabdominal (TAPP) approach. The authors here present their experience with totally extraperitoneal (TEP) repair of acutely incarcerated hernia. Methods: A retrospective review was undertaken to evaluate the authors' experience with this procedure over a 4-year period. There were 16 cases, 5 of which were performed using a conventional anterior repair. These 5 cases were excluded from the review. The surgery for all of the remaining 11 acutely incarcerated hernias was started laparoscopically using the TEP approach. Eight of the cases were completed this way, whereas three were converted to the open procedure. In addition to standard TEP repair techniques, a releasing incision is required for acutely incarcerated direct, indirect, or femoral hernias. With a direct hernia, the opening of the defect is enlarged to allow safe dissection of its contents. A releasing incision is made at the anteromedial aspect of the defect to avoid injury to the epigastric or iliac vessels. With an indirect hernia, several additional steps are required. The epigastric vessels may be divided; an additional trocar may be placed laterally below the linea semicircularis to facilitate dissection of the sac and to assist with suturing of the divided sac; and the deep internal ring is divided anteriorly at the 12 o'clock position toward the external ring, facilitating dissection of the indirect sac. With a femoral hernia, a releasing incision is made by carefully incising the insertion of the iliopubic tract into Cooper's ligament at the medial portion of the femoral ring. Results: The mean operative time was 50 min (range, 20-120 min), and the length of hospital stay was 5.4 days (range, 1-29 days). During a follow-up period of 9 to 69 months, there was no recurrence, and only two complications. One of these complications was an infected mesh that occurred in a case involving cecal injury. It was treated with continuous irrigation and salvaged. The other complication was a midline wound infection after a small bowel resection for a strangulated obturator hernia. Conclusions: Familiarity with the anatomy involved leads to the conclusion that the laparoscopic approach, specifically the TEP procedure, can be used without hesitation even in cases of acutely incarcerated hernia.

AB - Background: Laparoscopic treatment of acutely incarcerated inguinal hernia is uncommon and still controversial. Those being performed almost all use the transabdominal (TAPP) approach. The authors here present their experience with totally extraperitoneal (TEP) repair of acutely incarcerated hernia. Methods: A retrospective review was undertaken to evaluate the authors' experience with this procedure over a 4-year period. There were 16 cases, 5 of which were performed using a conventional anterior repair. These 5 cases were excluded from the review. The surgery for all of the remaining 11 acutely incarcerated hernias was started laparoscopically using the TEP approach. Eight of the cases were completed this way, whereas three were converted to the open procedure. In addition to standard TEP repair techniques, a releasing incision is required for acutely incarcerated direct, indirect, or femoral hernias. With a direct hernia, the opening of the defect is enlarged to allow safe dissection of its contents. A releasing incision is made at the anteromedial aspect of the defect to avoid injury to the epigastric or iliac vessels. With an indirect hernia, several additional steps are required. The epigastric vessels may be divided; an additional trocar may be placed laterally below the linea semicircularis to facilitate dissection of the sac and to assist with suturing of the divided sac; and the deep internal ring is divided anteriorly at the 12 o'clock position toward the external ring, facilitating dissection of the indirect sac. With a femoral hernia, a releasing incision is made by carefully incising the insertion of the iliopubic tract into Cooper's ligament at the medial portion of the femoral ring. Results: The mean operative time was 50 min (range, 20-120 min), and the length of hospital stay was 5.4 days (range, 1-29 days). During a follow-up period of 9 to 69 months, there was no recurrence, and only two complications. One of these complications was an infected mesh that occurred in a case involving cecal injury. It was treated with continuous irrigation and salvaged. The other complication was a midline wound infection after a small bowel resection for a strangulated obturator hernia. Conclusions: Familiarity with the anatomy involved leads to the conclusion that the laparoscopic approach, specifically the TEP procedure, can be used without hesitation even in cases of acutely incarcerated hernia.

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