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Two-stage laparoscopic treatment for strangulated inguinal, femoral and obturator hernias: totally extraperitoneal repair followed by intestinal resection assisted by intraperitoneal laparoscopic exploration

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Abstract

Purpose

Total extraperitoneal preperitoneal (TEP) repair is widely used for inguinal, femoral, or obturator hernia treatment. However, mesh repair is not often used for strangulated hernia treatment if intestinal resection is required because of the risk of postoperative mesh infection. Complete mesh repair is required for hernia treatment to prevent postoperative recurrence, particularly in patients with femoral or obturator hernia.

Cases

We treated four patients with inguinocrural and obturator hernias (a 72-year-old male with a right indirect inguinal hernia; an 83-year-old female with a right obturator hernia; and 86- and 82-year-old females with femoral hernias) via a two-stage laparoscopic surgery. All patients were diagnosed with intestinal obstruction due to strangulated hernia. First, the incarcerated small intestine was released and then laparoscopically resected. Further, 8–24 days after the first surgery, bilateral TEP repairs were performed in all patients; the postoperative course was uneventful in all patients, and they were discharged 5–10 days after TEP repair. At present, no hernia recurrence has been reported in any patient.

Conclusion

The two-stage laparoscopic treatment is safe for treatment of strangulated inguinal, femoral, and obturator hernias, and complete mesh repair via the TEP method can be performed in elderly patients to minimize the occurrence of mesh infection.

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Acknowledgments

The authors would like to thank Enago (www.enago.jp) for the English language review.

Conflict of interest

Dr. Sasaki has nothing to disclose. Dr. Takeuchi has nothing to disclose. Dr. Izumi has nothing to disclose. Dr. Morimoto has nothing to disclose. Dr. Inomata has nothing to disclose. Dr. Kitano has nothing to disclose.

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Authors and Affiliations

  1. Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan

    A. Sasaki, Y. Takeuchi, K. Izumi & A. Morimoto

  2. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, 879-5593, Japan

    M. Inomata & S. Kitano

Authors
  1. A. Sasaki
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  2. Y. Takeuchi
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  3. K. Izumi
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  4. A. Morimoto
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  5. M. Inomata
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  6. S. Kitano
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Correspondence to A. Sasaki.

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Sasaki, A., Takeuchi, Y., Izumi, K. et al. Two-stage laparoscopic treatment for strangulated inguinal, femoral and obturator hernias: totally extraperitoneal repair followed by intestinal resection assisted by intraperitoneal laparoscopic exploration. Hernia 20, 483–488 (2016). https://doi.org/10.1007/s10029-014-1272-2

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  • DOI: https://doi.org/10.1007/s10029-014-1272-2

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