Planned reduction of incarcerated groin hernias with hernia sac laparoscopy.
BACKGROUND
Laparoscopic techniques have been described as adjuncts in the management of acutely incarcerated groin hernias, with the intention of reducing operative morbidity and patients discomfort. However, the use of laparoscopy in acute incarcerations, as well as its appropriateness, remains to be elucidated. Herein we discuss the use of hernia sac laparoscopy in the algorithm of managing incarcerated groin hernias.


METHODS
Five patients presenting with small bowel obstruction secondary to incarcerated groin hernias underwent surgical reduction of the hernia followed by hernia sac laparoscopy. The purpose of hernia sac laparoscopy was to determine the viability of the incarcerated bowel segment based on color, peristalsis, and venous congestion. When bowel resection was required, a separate incision was made after repair of the hernia.


RESULTS
Bowel viability was assessed accurately with this method. Although hemorrhagic fluid in the hernia sac was noted in three patients, only one patient required a limited exploration through a separate incision for nonviable bowel. Postoperative recovery was standard, with no morbidity or mortality. Patients were discharged in 2-5 days.


CONCLUSIONS
Hernia sac laparoscopy, without additional trocar placements, is a safe adjunct for determining the viability of the incarcerated bowel segment. This method reduces the need for laparotomy so long as the reduced incarcerated segment meets the criteria for viability. Videoscopic inspection potentially offers additional information, such as the existence of ascites and peritoneal tumors.
Lin
E
E
Department of Surgery, New York Hospital Medical Center of Queens, 56-45 Main Street, Flushing, NY 11355, USA.
Wear
K
K
Tiszenkel
H I
HI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006119:Groin; D006550:Hernia, Femoral / Q000150:complications / Q000601:surgery*; D006552:Hernia, Inguinal / Q000150:complications / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D016896:Treatment Outcome