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Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia

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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.

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References

  1. JS Barkin MH Wexler EJ Hichey D Thibeault JL Meakins (1995) ArticleTitleLaparoscopic versus open inguinal herniorrhaphy: preliminary results of a randomized controlled trial. Surgery 118 703–710 Occurrence Handle1:STN:280:BymD3cnjslE%3D Occurrence Handle7570325

    CAS  PubMed  Google Scholar 

  2. JR Bessell P Baxter P Riddell S Watkin GJ Maddem (1996) ArticleTitleA randomized controlled trial of laparoscopic extraperitoneal hernia repair as a day surgical procedure. Surg Endosc 10 495–500 Occurrence Handle1:STN:280:BymB2s%2FitVE%3D Occurrence Handle8658325

    CAS  PubMed  Google Scholar 

  3. G Champault N Rizk JM Catheline R Turner P Boutelier (1997) ArticleTitleInguinal hernia repair: totally preperitoneal laparoscopic approach versus Stoppa operation, randomized trial: 100 cases. Hernia 1 31–36

    Google Scholar 

  4. EL Felix CA Michas MH Gonzales (1995) ArticleTitleLaparoscopic hernioplasty: TAPP vs TEP. Surg Endosc 9 984–989 Occurrence Handle1:STN:280:BymD2snlslY%3D Occurrence Handle7482218

    CAS  PubMed  Google Scholar 

  5. GS Ferzli T Kiel (1997) ArticleTitleThe role of endoscopic extraperitoneal approach in large inguinal scrotal hernias. Surg Endosc 11 299–302 Occurrence Handle10.1007/s004649900350 Occurrence Handle1:STN:280:ByiB3snnsVA%3D Occurrence Handle9079616

    Article  CAS  PubMed  Google Scholar 

  6. RJ Fitzgibbons J Camps D Cornet NX Nguyen BS Litke R Annibali GM Salerno (1995) ArticleTitleLaparoscopic inguinal herniorrhaphy: results of a multicenter trial. Ann Surg 221 2–13

    Google Scholar 

  7. NC Gallegos J Dawson M Jarvis M Hobsley (1991) ArticleTitleRisk of strangulation in groin hernias. Br J Surg 78 1171–1173 Occurrence Handle1:STN:280:By2D28bltlA%3D Occurrence Handle1958976

    CAS  PubMed  Google Scholar 

  8. T Ishihara K Kubota N Eda S Ishihasshi Y Haraguchi (1996) ArticleTitleLaparoscopic approach to incarcerated inguinal hernia. Surg Endosc 10 1111–1113 Occurrence Handle10.1007/s004649900254 Occurrence Handle1:STN:280:ByiD2crgslQ%3D Occurrence Handle8881066

    Article  CAS  PubMed  Google Scholar 

  9. B Johansson B Hallerback H Glise B Anesten S Smedberg J Roman (1999) ArticleTitleLaparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair. Ann Surg 230 225–231 Occurrence Handle10450737

    PubMed  Google Scholar 

  10. A Kald B Anderberg P Carlson PO Park K Smedh (1997) ArticleTitleSurgical outcome and cost-minimization analysis of laparoscopic and open hernia repair: a randomized prospective trial with one year follow-up. Eur J Surg 163 505–510 Occurrence Handle1:STN:280:ByiA1M%2FgsVE%3D Occurrence Handle9248984

    CAS  PubMed  Google Scholar 

  11. A Kald B Anderberg K Smedh M Karlson (1997) ArticleTitleTransperitoneal or totally extraperitoneal approach in laparoscopic hernia repair: results of 491 consecutive herniorrhaphies. Surg Laparosc Endosc 7 86–89 Occurrence Handle1:STN:280:ByiB28zgt1A%3D Occurrence Handle9109232

    CAS  PubMed  Google Scholar 

  12. M Lavonius J Ovaska (2000) ArticleTitleLaparoscopy in the evaluation of incarcerated mass in groin hernia. Surg Endosc 14 488–489 Occurrence Handle10.1007/s004640000018 Occurrence Handle1:STN:280:DC%2BD3cvitlWgsQ%3D%3D Occurrence Handle10858478

    Article  CAS  PubMed  Google Scholar 

  13. BJ Leibl P Daubler G Schmedt K Kraft R Bittner (2000) ArticleTitleLong-term results of a randomized clinical trial between laparoscopic hernioplasty and Shouldice repair. Br J Surg 87 780–783 Occurrence Handle10848859

    PubMed  Google Scholar 

  14. BJ Leibl GC Schmedt K Kraft B Kraft R Bittner (2000) ArticleTitleLaparoscopic transperitoneal hernia repair of incarcerated hernias: Is it feasible? Results of a prospective study. Surg Endosc 15 1179–1183

    Google Scholar 

  15. MS Liem E Duyn Y Graaf T Vroonhoven (2003) ArticleTitleRecurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 237 135–141 Occurrence Handle10.1097/00000658-200301000-00019

    Article  Google Scholar 

  16. MS Liem Y van der Graaf CJ van Steensel RU Boelhouwer GJ Clevers WS Meijer LP Stassen JP Vente WF Weidema AJ Schrijvers TJ van Vroonhoven (1997) ArticleTitleComparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. N Engl J Med 336 1541–1547 Occurrence Handle1:STN:280:ByiB1M7jsF0%3D Occurrence Handle9164809

    CAS  PubMed  Google Scholar 

  17. BV MacFadyen CR Mathis (1994) ArticleTitleInguinal herniorrhaphy: complications and recurrences. Semin Laparosc Surg 1 128–140 Occurrence Handle10401048

    PubMed  Google Scholar 

  18. D Neuhauser (1977) Elective inguinal herniorrhaphy versus truss in the elderly. JP Bunker BA Barnes F Mosteller (Eds) Costs, risk, and benefits for surgery. Oxford University Press New York 223–239

    Google Scholar 

  19. AM Paganini E Lezoche F Carle F Favretti F Feliciotti R Gesuito M Gherrieri D Lomanto M Nardovino M Panti P Ribichini L Sarli M Sottili A Tamburini A Taschiere (1998) ArticleTitleA randomized, controlled, clinical study of laparoscopic vs open tension-free inguinal hernia repair. Surg Endosc 12 979–986 Occurrence Handle1:STN:280:DyaK1c3pvVehsQ%3D%3D Occurrence Handle9632874

    CAS  PubMed  Google Scholar 

  20. JH Payne LM Grinninger Mt Izawa EF Powell PJ Lindahl J Balfour (1994) ArticleTitleLaparoscopic or open inguinal herniorrhaphy? A randomized prospective trial. Arch Surg 129 973–981 Occurrence Handle8080380

    PubMed  Google Scholar 

  21. BJ Ramshaw JG Tucker T Conner EM Mason TD Duncan GW Lucas (1996) ArticleTitleA comparison of the approaches to laparoscopic herniorrhaphy. Surg Endosc 10 29–32 Occurrence Handle10.1007/s004649910006 Occurrence Handle1:STN:280:BymB28znsl0%3D Occurrence Handle8711601

    Article  CAS  PubMed  Google Scholar 

  22. P Sayad G Ferzli (1999) ArticleTitleThe extraperitoneal approach and its utility. Surg Endosc 13 1168–1169 Occurrence Handle10.1007/s004649901199 Occurrence Handle1:STN:280:DC%2BD3c%2FivVChuw%3D%3D Occurrence Handle10556465

    Article  CAS  PubMed  Google Scholar 

  23. DL Stoker DJ Spielgelhalter R Singh JM Wellwood (1994) ArticleTitleLaparoscopic versus open inguinal hernia repair: randomized prospective trial. Lancet 343 1243–1245 Occurrence Handle1:STN:280:ByuB3sbgslQ%3D Occurrence Handle7910272

    CAS  PubMed  Google Scholar 

  24. C Tamme H Scheidbach C Hampe C Schneider F Kockerling (2003) ArticleTitleTotally extraperitoneal endoscopic inguinal hernia repair (TEP). Surg Endosc 17 190–195 Occurrence Handle10.1007/s00464-002-8905-8 Occurrence Handle1:STN:280:DC%2BD3s%2Fms12qsQ%3D%3D Occurrence Handle12457220

    Article  CAS  PubMed  Google Scholar 

  25. J Tschudi M Wagner C Klaiber JJ Brugger E Frei L Krahenbuhl R Inderbitzi J Boinski SF Hsu Schmitz J Husler (1996) ArticleTitleControlled multicenter trial of laparoscopic transabdominal preperitoneal vs Shouldice herniorrhaphy. Surg Endosc 10 845–847 Occurrence Handle1:STN:280:BymA2M7gtVI%3D Occurrence Handle8694951

    CAS  PubMed  Google Scholar 

  26. DM Vogt MJ Curet DE Pitcher DT Martin KA Zucker (1995) ArticleTitlePreliminary results of a prospective randomized trial of laparoscopic onlay versus conventional inguinal herniorrhaphy. Am J Surg 169 84–90 Occurrence Handle10.1016/S0002-9610(99)80114-7 Occurrence Handle1:STN:280:ByqC3Mjns1I%3D Occurrence Handle7818003

    Article  CAS  PubMed  Google Scholar 

  27. SD Watson W Saye PA Hollier (1993) ArticleTitleCombined laparoscopic incarcerated herniorrhaphy and small bowel resection. Surg Laparosc Endosc 3 106–108 Occurrence Handle1:STN:280:ByuD1Mvgt1E%3D Occurrence Handle8269227

    CAS  PubMed  Google Scholar 

  28. J Wellwood MJ Sculpher D Stoker GJ Nicholls C Geddes A Whitehead R Singh D Spiegelhater (1998) ArticleTitleRandomized controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. Br Med J 317 103–110 Occurrence Handle1:STN:280:DyaK1czit1Wqsg%3D%3D

    CAS  Google Scholar 

  29. DM Wright A Kennedy JN Baxter GM Fullarton LM Fife GT Sunderland PJ O’Dwyer (1996) ArticleTitleEarly outcome after open versus extraperitoneal endoscopic tension-free hernioplasty: a randomized clinical trial. Surgery 19 552–557

    Google Scholar 

  30. J Zieren HU Zieren CA Jacobe FA Wenger JM Muller (1998) ArticleTitleProspective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice’s operation. Am J Surg 175 330–333 Occurrence Handle9568665

    PubMed  Google Scholar 

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Authors and Affiliations

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

    G. Ferzli, K. Shapiro, G. Chaudry & S. Patel

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  1. G. Ferzli
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  2. K. Shapiro
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  3. G. Chaudry
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  4. S. Patel
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Correspondence to G. Ferzli.

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Ferzli, G., Shapiro, K., Chaudry, G. et al. Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia . Surg Endosc 18, 228–231 (2004). https://doi.org/10.1007/s00464-003-8185-y

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