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Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia

  • G. Ferzli
  • K. Shapiro
  • G. Chaudry
  • S. Patel
Original article

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.

Keywords

Inguinal hernia Laparoscopy Incarcerated TEP 

References

  1. 1.
    Barkin, JS, Wexler, MH, Hichey, EJ, Thibeault, D, Meakins, JL 1995Laparoscopic versus open inguinal herniorrhaphy: preliminary results of a randomized controlled trial.Surgery118703710PubMedGoogle Scholar
  2. 2.
    Bessell, JR, Baxter, P, Riddell, P, Watkin, S, Maddem, GJ 1996A randomized controlled trial of laparoscopic extraperitoneal hernia repair as a day surgical procedure.Surg Endosc10495500PubMedGoogle Scholar
  3. 3.
    Champault, G, Rizk, N, Catheline, JM, Turner, R, Boutelier, P 1997Inguinal hernia repair: totally preperitoneal laparoscopic approach versus Stoppa operation, randomized trial: 100 cases.Hernia13136Google Scholar
  4. 4.
    Felix, EL, Michas, CA, Gonzales, MH 1995Laparoscopic hernioplasty: TAPP vs TEP.Surg Endosc9984989PubMedGoogle Scholar
  5. 5.
    Ferzli, GS, Kiel, T 1997The role of endoscopic extraperitoneal approach in large inguinal scrotal hernias.Surg Endosc11299302CrossRefPubMedGoogle Scholar
  6. 6.
    Fitzgibbons, RJ, Camps, J, Cornet, D, Nguyen, NX, Litke, BS, Annibali, R, Salerno, GM 1995Laparoscopic inguinal herniorrhaphy: results of a multicenter trial.Ann Surg221213Google Scholar
  7. 7.
    Gallegos, NC, Dawson, J, Jarvis, M, Hobsley, M 1991Risk of strangulation in groin hernias.Br J Surg7811711173PubMedGoogle Scholar
  8. 8.
    Ishihara, T, Kubota, K, Eda, N, Ishihasshi, S, Haraguchi, Y 1996Laparoscopic approach to incarcerated inguinal hernia.Surg Endosc1011111113CrossRefPubMedGoogle Scholar
  9. 9.
    Johansson, B, Hallerback, B, Glise, H, Anesten, B, Smedberg, S, Roman, J 1999Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair.Ann Surg230225231PubMedGoogle Scholar
  10. 10.
    Kald, A, Anderberg, B, Carlson, P, Park, PO, Smedh, K 1997Surgical outcome and cost-minimization analysis of laparoscopic and open hernia repair: a randomized prospective trial with one year follow-up.Eur J Surg163505510PubMedGoogle Scholar
  11. 11.
    Kald, A, Anderberg, B, Smedh, K, Karlson, M 1997Transperitoneal or totally extraperitoneal approach in laparoscopic hernia repair: results of 491 consecutive herniorrhaphies.Surg Laparosc Endosc78689PubMedGoogle Scholar
  12. 12.
    Lavonius, M, Ovaska, J 2000Laparoscopy in the evaluation of incarcerated mass in groin hernia.Surg Endosc14488489CrossRefPubMedGoogle Scholar
  13. 13.
    Leibl, BJ, Daubler, P, Schmedt, G, Kraft, K, Bittner, R 2000Long-term results of a randomized clinical trial between laparoscopic hernioplasty and Shouldice repair.Br J Surg87780783PubMedGoogle Scholar
  14. 14.
    Leibl, BJ, Schmedt, GC, Kraft, K, Kraft, B, Bittner, R 2000Laparoscopic transperitoneal hernia repair of incarcerated hernias: Is it feasible? Results of a prospective study.Surg Endosc1511791183Google Scholar
  15. 15.
    Liem, MS, Duyn, E, Graaf, Y, Vroonhoven, T 2003Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison.Ann Surg237135141CrossRefGoogle Scholar
  16. 16.
    Liem, MS, van der Graaf, Y, van Steensel, CJ, Boelhouwer, RU, Clevers, GJ, Meijer, WS, Stassen, LP, Vente, JP, Weidema, WF, Schrijvers, AJ, van Vroonhoven, TJ 1997Comparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair.N Engl J Med33615411547PubMedGoogle Scholar
  17. 17.
    MacFadyen, BV, Mathis, CR 1994Inguinal herniorrhaphy: complications and recurrences.Semin Laparosc Surg1128140PubMedGoogle Scholar
  18. 18.
    Neuhauser, D 1977Elective inguinal herniorrhaphy versus truss in the elderly.Bunker, JPBarnes, BAMosteller, F eds. Costs, risk, and benefits for surgery.Oxford University PressNew York223239Google Scholar
  19. 19.
    Paganini, AM, Lezoche, E, Carle, F, Favretti, F, Feliciotti, F, Gesuito, R, Gherrieri, M, Lomanto, D, Nardovino, M, Panti, M, Ribichini, P, Sarli, L, Sottili, M, Tamburini, A, Taschiere, A 1998A randomized, controlled, clinical study of laparoscopic vs open tension-free inguinal hernia repair.Surg Endosc12979986PubMedGoogle Scholar
  20. 20.
    Payne, JH, Grinninger, LM, Izawa, Mt, Powell, EF, Lindahl, PJ, Balfour, J 1994Laparoscopic or open inguinal herniorrhaphy? A randomized prospective trial.Arch Surg129973981PubMedGoogle Scholar
  21. 21.
    Ramshaw, BJ, Tucker, JG, Conner, T, Mason, EM, Duncan, TD, Lucas, GW 1996A comparison of the approaches to laparoscopic herniorrhaphy.Surg Endosc102932CrossRefPubMedGoogle Scholar
  22. 22.
    Sayad, P, Ferzli, G 1999The extraperitoneal approach and its utility.Surg Endosc1311681169CrossRefPubMedGoogle Scholar
  23. 23.
    Stoker, DL, Spielgelhalter, DJ, Singh, R, Wellwood, JM 1994Laparoscopic versus open inguinal hernia repair: randomized prospective trial.Lancet34312431245PubMedGoogle Scholar
  24. 24.
    Tamme, C, Scheidbach, H, Hampe, C, Schneider, C, Kockerling, F 2003Totally extraperitoneal endoscopic inguinal hernia repair (TEP).Surg Endosc17190195CrossRefPubMedGoogle Scholar
  25. 25.
    Tschudi, J, Wagner, M, Klaiber, C, Brugger, JJ, Frei, E, Krahenbuhl, L, Inderbitzi, R, Boinski, J, Hsu Schmitz, SF, Husler, J 1996Controlled multicenter trial of laparoscopic transabdominal preperitoneal vs Shouldice herniorrhaphy.Surg Endosc10845847PubMedGoogle Scholar
  26. 26.
    Vogt, DM, Curet, MJ, Pitcher, DE, Martin, DT, Zucker, KA 1995Preliminary results of a prospective randomized trial of laparoscopic onlay versus conventional inguinal herniorrhaphy.Am J Surg1698490CrossRefPubMedGoogle Scholar
  27. 27.
    Watson, SD, Saye, W, Hollier, PA 1993Combined laparoscopic incarcerated herniorrhaphy and small bowel resection.Surg Laparosc Endosc3106108PubMedGoogle Scholar
  28. 28.
    Wellwood, J, Sculpher, MJ, Stoker, D, Nicholls, GJ, Geddes, C, Whitehead, A, Singh, R, Spiegelhater, D 1998Randomized controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost.Br Med J317103110Google Scholar
  29. 29.
    Wright, DM, Kennedy, A, Baxter, JN, Fullarton, GM, Fife, LM, Sunderland, GT, O’Dwyer, PJ 1996Early outcome after open versus extraperitoneal endoscopic tension-free hernioplasty: a randomized clinical trial.Surgery19552557Google Scholar
  30. 30.
    Zieren, J, Zieren, HU, Jacobe, CA, Wenger, FA, Muller, JM 1998Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice’s operation.Am J Surg175330333PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of SurgeryStaten Island University Hospital, 65 Cromwell Avenue, Staten Island, NY 10304USA

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