title: Total extraperitoneal (TEP) hernioplasty with intestinal resection assisted by laparoscopy for a strangulated Richter femoral hernia.
abstract: We describe the first clinical case of a total extraperitoneal hernioplasty combined with intestinal resection assisted by laparoscopy for a strangulated Richter femoral hernia. The patient was a 94-year-old woman admitted to the emergency room with signs and symptoms of acute small bowel obstruction. Diagnosis of a strangulated left Richter femoral hernia was only possible during the initial exploratory laparoscopy. The extraperitoneal approach for mesh positioning was performed gaining access through an infraumbilical 12 mm trocar incision, and assistance of two 5 mm laparoscopic ports at the hipogastrium and right flank. Laparoscopy was resumed and segmental intestinal resection with primary anastomosis was performed. The patient recovered without complications and was discharged home at the fourth postoperative day. The total extraperitoneal approach for acute hernia repair was successful in our particular case. However, factors such as laparoscopic surgical experience, careful patient selection, and correct preoperative diagnosis must be considered before studies in the emergency setting.
authors.affiliation: Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Cesar
authors.initials: C
authors.lastname: Ginestà
authors.forename: David
authors.initials: D
authors.lastname: Saavedra-Perez
authors.forename: Mauro
authors.initials: M
authors.lastname: Valentini
authors.forename: Oscar
authors.initials: O
authors.lastname: Vidal
authors.forename: Guerson
authors.initials: G
authors.lastname: Benarroch
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Valdecasas
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006550:Hernia, Femoral / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007082:Ileum / Q000601:surgery*; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D010537:Peritoneum; D014057:Tomography, X-Ray Computed