Advertisement

Strangulated Inguinal Hernia: Options and Strategies

  • Kara A. Vande Walle
  • Jacob A. GreenbergEmail author
Chapter

Abstract

Although inguinal hernias are common, the incidence of strangulated inguinal hernias is low. Strangulated inguinal hernias occur when blood supply to the incarcerated structures is compromised leading to ischemia, necrosis, and perforation. As a result, strangulated inguinal hernias are a surgical emergency to prevent progression to perforation. Operative approaches include open tissue-based repairs, open mesh-based repairs, and minimally invasive repairs. The approach that is selected depends on the patient’s presentation, the patient’s prior operations, and surgeon experience. Tissue-based repairs should be performed when there is diffuse peritonitis or gross contamination due to concern for infection. Mesh-based repairs should be performed if the entire bowel is viable due to the low rate of hernia recurrence. In the event a bowel resection must be performed, the decision to perform a tissue-based or mesh-based repair should be made on a case-by-case basis. Regardless of the approach selected, immediate intervention is required to obtain the best outcomes.

Keywords

Inguinal Hernia Strangulated Mesh Totally extraperitoneal Transabdominal preperitoneal 

References

  1. 1.
    Hernandez-Irizarry R, Zendejas B, Ramirez T, et al. Trends in emergent inguinal hernia surgery in Olmstead County, MN: a population-based study. Hernia. 2012;16:397–403.CrossRefGoogle Scholar
  2. 2.
    Fitzgibbons RJ, Ramanan B, Arya S, et al. Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg. 2013;258:508–15.CrossRefGoogle Scholar
  3. 3.
    Chung L, Norrie J, O’Dwyer P. Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial. Br J Surg. 2011;98:596–9.CrossRefGoogle Scholar
  4. 4.
    Karatepe O, Adas G, Battal M, et al. The comparison of preperitoneal and Lichtenstein repair for incarcerated groin hernias: a randomised controlled trial. Int J Surg. 2008;6(3):189–92.CrossRefGoogle Scholar
  5. 5.
    Morris-Stiff G, Hassn A. Hernioscopy: a useful technique for the evaluation of incarcerated hernias that retract under anaesthesia. Hernia. 2008;12(2):133–5.CrossRefGoogle Scholar
  6. 6.
    Pearl JP, Ritter EM. Strangulated inguinal hernia. In: Jacob BP, Ramshaw B, editors. The SAGES manual of hernia repair. New York: Springer; 2013. p. 91–102.CrossRefGoogle Scholar
  7. 7.
    Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.CrossRefGoogle Scholar
  8. 8.
    Bessa SS, Abdel-Fattah MR, Al-Sayes IA, Korayem IT. Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated groin hernias: a 10-year study. Hernia. 2015;19(6):909–14.CrossRefGoogle Scholar
  9. 9.
    Pans A, Desaive C, Jacquet N. Use of a preperitoneal prosthesis for strangulated groin hernia. Br J Surg. 1997;84(3):310–2.CrossRefGoogle Scholar
  10. 10.
    Wysocki A, Pozniczek M, Krzywon J, Bolt L. Use of polypropylene prostheses for strangulated inguinal and incisional hernias. Hernia. 2001;5(2):105–6.CrossRefGoogle Scholar
  11. 11.
    Wysocki A, Pozniczek M, Krzywon J, Strzalka M. Lichtenstein repair for incarcerated groin hernias. Eur J Surg. 2002;168(8–9):452–4.CrossRefGoogle Scholar
  12. 12.
    Papaziogas B, Lazaridis C, Makris J, et al. Tension-free repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: a comparative study. Hernia. 2005;9(2):156–9.CrossRefGoogle Scholar
  13. 13.
    Wysocki A, Kulawik J, Pozniczek M, Strzalka M. Is the Lichtenstein operation of strangulated groin hernia a safe procedure? World J Surg. 2006;30(11):2065–70.CrossRefGoogle Scholar
  14. 14.
    Bessa SS, Katri KM, Abdel-Salam WN, Abdel-Baki NA. Early results from the use of the Lichtenstein repair in the management of strangulated groin hernia. Hernia. 2007;11(3):239–42.CrossRefGoogle Scholar
  15. 15.
    Atila K, Guler S, Inal A, Sokmen S, Karademir S, Bora S. Prosthetic repair of acutely incarcerated groin hernias: a prospective clinical observational cohort study. Langenbeck’s Arch Surg. 2010;395(5):563–8.CrossRefGoogle Scholar
  16. 16.
    Derici H, Unalp HR, Nazli O, et al. Prosthetic repair of incarcerated inguinal hernias: is it a reliable method? Langenbeck’s Arch Surg. 2010;395(5):575–9.CrossRefGoogle Scholar
  17. 17.
    Sawayama H, Kanemitsu K, Okuma T, Inoue K, Yamamoto K, Baba H. Safety of polypropylene mesh for incarcerated groin and obturator hernias: a retrospective study of 110 patients. Hernia. 2014;18(3):399–406.CrossRefGoogle Scholar
  18. 18.
    Hentati H, Dougaz W, Dziri C. Mesh repair versus non-mesh repair for strangulated inguinal hernia: systematic review with meta-analysis. World J Surg. 2014;38(11):2784–90.CrossRefGoogle Scholar
  19. 19.
    Nieuwenhuizen J, van Ramshorst GH, ten Brinke JG, et al. The use of mesh in acute hernia: frequency and outcome in 99 cases. Hernia. 2011;15(3):297–300.CrossRefGoogle Scholar
  20. 20.
    Ferzli G, Shapiro K, Chaudry G, Patel S. Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia. Surg Endosc. 2004;18(2):228–31.CrossRefGoogle Scholar
  21. 21.
    Sasaki A, Takeuchi Y, Izumi K, Morimoto A, Inomata M, Kitano S. Two-stage laparoscopic treatment for strangulated inguinal, femoral and obturator hernias: totally extraperitoneal repair followed by intestinal resection assisted by intraperitoneal laparoscopic exploration. Hernia. 2016;20(3):483–8.CrossRefGoogle Scholar
  22. 22.
    McCormack K, Scott N, Go PM, Ross SJ, Grant A. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;(1):CD001785.Google Scholar
  23. 23.
    Yang GP, Chan CT, Lai EC, Chan OC, Tang CN, Li MK. Laparoscopic versus open repair for strangulated groin hernias: 188 cases over 4 years. Asian J Endosc Surg. 2012;5(3):131–7.CrossRefGoogle Scholar
  24. 24.
    Rebuffat C, Galli A, Scalambra MS, Balsamo F. Laparoscopic repair of strangulated hernias. Surg Endosc. 2006;20(1):131–4.CrossRefGoogle Scholar
  25. 25.
    Legnani GL, Rasini M, Pastori S, Sarli D. Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguino-crural hernias: a report of nine cases. Hernia. 2008;12(2):185–8.CrossRefGoogle Scholar
  26. 26.
    Deeba S, Purkayastha S, Paraskevas P, Athanasiou T, Darzi A, Zacharakis E. Laparoscopic approach to incarcerated and strangulated inguinal hernias. JSLS. 2009;13(3):327–31.PubMedPubMedCentralGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of WisconsinMadisonUSA

Personalised recommendations