title: Laparoscopic transabdominal approach and its modified technique for incarcerated scrotal hernias.
abstract: BACKGROUND
  Using laparoscopic methods for incarcerated scrotal hernias is controversial because of the perceived technical difficulties in treating such hernias. Herein, we present our experience with laparoscopic repair of such hernias.
  
  
  METHODS
  A retrospective review was undertaken to evaluate our experience with laparoscopic transabdominal approach and its modification for incarcerated hernias over a 3-year period. Two laparoscopic techniques were used for the repair of such hernias. The first technique, an exploratory laparoscopy, was performed to inspect the content of the hernia. This was followed by gentle retraction of the hernial content into the abdominal cavity and performing a standard transabdominal preperitoneal (TAPP) repair. If the hernia was not reducible, then a second technique involving a paramedian scrotal incision was performed. The sac was isolated, opened, and its contents were examined. If the bowel was encountered, it was reduced into the peritoneal cavity. However, if it was the omentum, it was excised. Following ligation of the scrotal sac and re-insufflation of the abdomen, a standard TAPP ensued.
  
  
  RESULTS
  A total of 20 male patients with incarcerated scrotal hernia underwent laparoscopic TAPP repair (mean age: 48 years). Six had scrotal incision. Surgical site or mesh infection was not observed in any of the cases. Likewise, no recurrence after a mean follow-up of 22 months was encountered.
  
  
  CONCLUSIONS
  Using the above modifications, we were able to perform laparoscopic repair of large incarcerated scrotal hernias, which previously would have been treated with an open procedure.
authors.affiliation: Department of Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia. szeli18@yahoo.com
authors.forename: Sze Li
authors.initials: SL
authors.lastname: Siow
authors.forename: Hans Alexander
authors.initials: HA
authors.lastname: Mahendran
authors.forename: Mark
authors.initials: M
authors.lastname: Hardin
authors.forename: Chan Hooi
authors.initials: CH
authors.lastname: Chea
authors.forename: Nik Abdullah
authors.initials: NA
authors.lastname: Nik Azim
mesh_terms: D000328:Adult; D000368:Aged; D005832:Genital Diseases, Male / Q000601:surgery*; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012611:Scrotum