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KMID : 0978820100130020139
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2010 Volume.13 No. 2 p.139 ~ p.143
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A Totally Extraperitoneal (TEP) Laparoscopic Approach to Incarcerated Inguinal Hernia
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Chung Choon-Sik
Lee Jeong-Eun
Joh Yong-Geul
Yoo Sang-Hwa
Jeong Gyu-Young
Kim Seung-Han
Lee Dong-Keun
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Abstract
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Purpose: Laparoscopic herniorrhaphy (LH) has an advantage for evaluating the viability of incarcerated bowel. In this retrospective study, we aimed to review the data for use of the TEP technique in treating incarcerated hernias in order to document the feasibility of the laparoscopic procedure.
Methods: During a 2-year period from January 2008 to December 2009, one surgeon (C.S) at our institution operated on 27 patients with acutely (n=3) or chronically (n=24) incarcerated hernia. Incarcerated hernias were divided into acute or chronic types arbitrarily, based on who had symptoms of acute abdominal pain and signs of intestinal obstruction. For acute cases, the TEP procedure was done following laparoscopic transperitoneal evaluation to assess viability of the incarcerated bowel.
Results: All patients except one having a femoral hernia were male. Mean age was 41 years old (range, 25∼75). No case converted from a laparoscopic to an open procedure. Two acute incarcerated cases contained a segment of small bowel and the other contained small bowel and omentum. All acute cases were operated on successfully on an emergency basis by laparoscopic TEP repair. All chronic cases contained omentum without bowel. In one case of acute and seven cases of chronic type, a small inguinal incision was made to reduce hernia contents. No recurrence was noticed at a mean of 13 months of follow-up.
Conclusion: If there is no entrapment of bowel in chronic incarcerated cases, the TEP procedure will be satisfactory. It may be reasonable, however, to evaluate viability of bowel transperitoneally before doing a TEP procedure in acute cases.
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KEYWORD
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Laparoscopy, Total extraperitoneal repair, Incarcerated inguinal hernia
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