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The laparoscopic transperitoneal approach for irreducible inguinal hernias: Perioperative outcome in four patients.

Jagad RB, Shah J, Patel GR - J Minim Access Surg (2009)

Bottom Line: Laparoscopic transperitoneal approach has the advantage of observation of the hernia content for a longer period of time.The division of the internal ring can be done under direct vision.Other intra-abdominal pathology and opposite side hernia can be diagnosed and treated at the same time..

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, New Civil Hospital and Government Medical College, Surat, Gujarat, India.

ABSTRACT

Background: Incarceration and strangulation are the most feared complications of inguinal hernia. Till date, incarcerated hernias have traditionally been treated by conventional open repair. Reports are now available for the feasibility of laparoscopic repair of incarcerated inguinal hernia. Here, we described our experience with the transperitoneal approach for incarcerated hernias.

Materials and methods: Between January 2008 and May 2008, four patients were presented with a history of irreducible hernia, abdominal distention and vomiting. All the patients had right-sided inguinal hernia. Reductions of the hernia contents were not possible in any patient. The patients were treated on emergency basis with laparoscopic transabdominal preperitoneal hernia repair. Retrospective analyses of all the patients were done.

Results: Reduction of the bowel was achieved in all but one patient, who required the division of the internal ring on lateral side. Transperitoneal mesh repair was performed. No major complications were encountered. One patient developed seroma formation that was treated conservatively.

Conclusion: Laparoscopic transperitoneal approach has the advantage of observation of the hernia content for a longer period of time. The division of the internal ring can be done under direct vision. Other intra-abdominal pathology and opposite side hernia can be diagnosed and treated at the same time..

No MeSH data available.


Related in: MedlinePlus

Irreducible herniation of the small bowel through the deep ring
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Figure 0001: Irreducible herniation of the small bowel through the deep ring

Mentions: All patients were operated upon under general anaesthesia. A pneumoperitoneum was created by a Veress needle inserted just below the umbilicus. One 10 mm and two 5 mm trocars were inserted. Working trocars were inserted in the midclavicular line on both sides. Hernias were indirect and on the right side in all four patients [Figure 1]. Laparoscopic examination revealed herniation of a small bowel in three patients and sliding hernia with herniation of ileocaecal junction in one patient. The incarcerated small bowel was return to the abdominal cavity with ease in two patients. The other two patients required the division of the internal ring to bring the hernia content into the abdominal cavity [Figure 2]. The internal ring was opened on the lateral side. All the patients had congested but viable bowel when examined after reduction. Resection of the bowel was not required in any patient. After reduction of the hernia contents, the hernia was repaired by raising the peritoneal flap. The sac was divided at the deep ring and the distal sac was left behind in all the patients. A 15 × 12 cm sized Prolene mesh was kept and peritoneal flap was sutured. The mean operative time was of 114.5 minutes (range: 98–130 min). The postoperative course was uneventful in three patients. One patient developed seroma formation that was treated conservatively. An average hospital stay was of 2.75 days (range: 2–4 days) [Table 1]. The mean follow-up period was of 3 months (range: 1–6 months) without any recurrence.


The laparoscopic transperitoneal approach for irreducible inguinal hernias: Perioperative outcome in four patients.

Jagad RB, Shah J, Patel GR - J Minim Access Surg (2009)

Irreducible herniation of the small bowel through the deep ring
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2734896&req=5

Figure 0001: Irreducible herniation of the small bowel through the deep ring
Mentions: All patients were operated upon under general anaesthesia. A pneumoperitoneum was created by a Veress needle inserted just below the umbilicus. One 10 mm and two 5 mm trocars were inserted. Working trocars were inserted in the midclavicular line on both sides. Hernias were indirect and on the right side in all four patients [Figure 1]. Laparoscopic examination revealed herniation of a small bowel in three patients and sliding hernia with herniation of ileocaecal junction in one patient. The incarcerated small bowel was return to the abdominal cavity with ease in two patients. The other two patients required the division of the internal ring to bring the hernia content into the abdominal cavity [Figure 2]. The internal ring was opened on the lateral side. All the patients had congested but viable bowel when examined after reduction. Resection of the bowel was not required in any patient. After reduction of the hernia contents, the hernia was repaired by raising the peritoneal flap. The sac was divided at the deep ring and the distal sac was left behind in all the patients. A 15 × 12 cm sized Prolene mesh was kept and peritoneal flap was sutured. The mean operative time was of 114.5 minutes (range: 98–130 min). The postoperative course was uneventful in three patients. One patient developed seroma formation that was treated conservatively. An average hospital stay was of 2.75 days (range: 2–4 days) [Table 1]. The mean follow-up period was of 3 months (range: 1–6 months) without any recurrence.

Bottom Line: Laparoscopic transperitoneal approach has the advantage of observation of the hernia content for a longer period of time.The division of the internal ring can be done under direct vision.Other intra-abdominal pathology and opposite side hernia can be diagnosed and treated at the same time..

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, New Civil Hospital and Government Medical College, Surat, Gujarat, India.

ABSTRACT

Background: Incarceration and strangulation are the most feared complications of inguinal hernia. Till date, incarcerated hernias have traditionally been treated by conventional open repair. Reports are now available for the feasibility of laparoscopic repair of incarcerated inguinal hernia. Here, we described our experience with the transperitoneal approach for incarcerated hernias.

Materials and methods: Between January 2008 and May 2008, four patients were presented with a history of irreducible hernia, abdominal distention and vomiting. All the patients had right-sided inguinal hernia. Reductions of the hernia contents were not possible in any patient. The patients were treated on emergency basis with laparoscopic transabdominal preperitoneal hernia repair. Retrospective analyses of all the patients were done.

Results: Reduction of the bowel was achieved in all but one patient, who required the division of the internal ring on lateral side. Transperitoneal mesh repair was performed. No major complications were encountered. One patient developed seroma formation that was treated conservatively.

Conclusion: Laparoscopic transperitoneal approach has the advantage of observation of the hernia content for a longer period of time. The division of the internal ring can be done under direct vision. Other intra-abdominal pathology and opposite side hernia can be diagnosed and treated at the same time..

No MeSH data available.


Related in: MedlinePlus