title: Two-stage laparoscopic treatment for strangulated inguinal, femoral and obturator hernias: totally extraperitoneal repair followed by intestinal resection assisted by intraperitoneal laparoscopic exploration.
abstract: Total extraperitoneal preperitoneal (TEP) repair is widely used for inguinal, femoral, or obturator hernia treatment. However, mesh repair is not often used for strangulated hernia treatment if intestinal resection is required because of the risk of postoperative mesh infection. Complete mesh repair is required for hernia treatment to prevent postoperative recurrence, particularly in patients with femoral or obturator hernia.
  
  
  
  We treated four patients with inguinocrural and obturator hernias (a 72-year-old male with a right indirect inguinal hernia; an 83-year-old female with a right obturator hernia; and 86- and 82-year-old females with femoral hernias) via a two-stage laparoscopic surgery. All patients were diagnosed with intestinal obstruction due to strangulated hernia. First, the incarcerated small intestine was released and then laparoscopically resected. Further, 8-24 days after the first surgery, bilateral TEP repairs were performed in all patients; the postoperative course was uneventful in all patients, and they were discharged 5-10 days after TEP repair. At present, no hernia recurrence has been reported in any patient.
  
  
  
  The two-stage laparoscopic treatment is safe for treatment of strangulated inguinal, femoral, and obturator hernias, and complete mesh repair via the TEP method can be performed in elderly patients to minimize the occurrence of mesh infection.
authors.affiliation: Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan. sasakia@oita-u.ac.jp.
authors.forename: A
authors.initials: A
authors.lastname: Sasaki
authors.affiliation: Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Takeuchi
authors.affiliation: Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Izumi
authors.affiliation: Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Morimoto
authors.affiliation: Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, 879-5593, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Inomata
authors.affiliation: Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, 879-5593, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kitano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006550:Hernia, Femoral / Q000000981:diagnostic imaging / Q000601:surgery*; D006552:Hernia, Inguinal / Q000000981:diagnostic imaging / Q000601:surgery*; D006553:Hernia, Obturator / Q000000981:diagnostic imaging / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D007422:Intestines / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed
keywords: Geriatric patients; Mesh infection; Strangulated hernia; Total extraperitoneal repair; Two-stage laparoscopy