Hernioscopy: A Simple Application of Single-port Endoscopic Surgery in Acute Inguinal Hernias

Strangulated hernia remains one of the most common emergencies encountered in general surgery. During induction of general or spinal anesthesia, the potential self-reduction of a gangrenous bowel can occur in approximately 1% of cases. In these cases, bowel viability can no longer be directly assessed unless a more extensive operation (laparoscopy or laparotomy) is performed. A simple alternative to unnecessary laparotomy or to a standard laparoscopy is a hernia sac laparoscopy (hernioscopy). Here, we presented 4 patients with a diagnosis of small-bowel obstruction secondary to incarcerated inguinal hernias, in which the incarcerated hernia content was evaluated by hernioscopy. Only 1 case presented persistent signs of bowel ischemia after hernia reduction and required a small-bowel segmental resection. All hernias were repaired using prosthetic tension-free technique. Hernia sac laparoscopy (hernioscopy), the introduction of the laparoscope through an open inguinal hernia sac, can be useful to evaluate the viability of the incarcerated hernia content, to avoid unnecessary laparotomy.

[1]  Z. Ahmed,et al.  Laparoscopy through a groin hernia: An everyday application of natural orifice surgery. , 2011, The Surgeon.

[2]  G. Dedemadi,et al.  Laparoscopic versus open mesh repair for recurrent inguinal hernia: a meta-analysis of outcomes. , 2010, American journal of surgery.

[3]  T. Tang,et al.  Incidence of contralateral occult inguinal hernia found at the time of laparoscopic trans-abdominal pre-peritoneal (TAPP) repair , 2010, Hernia.

[4]  A. Darzi,et al.  Laparoscopic Approach to Incarcerated and Strangulated Inguinal Hernias , 2009, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[5]  G. Dedemadi,et al.  Assessment of Strangulated Content of the Spontaneously Reduced Inguinal Hernia via Hernia Sac Laparoscopy: Preliminary Results of a Prospective Randomized Study , 2009, Surgical laparoscopy, endoscopy & percutaneous techniques.

[6]  D. Sarli,et al.  Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguino-crural hernias: a report of nine cases , 2008, Hernia.

[7]  G. Morris-Stiff,et al.  Hernioscopy: a useful technique for the evaluation of incarcerated hernias that retract under anaesthesia , 2008, Hernia.

[8]  V. Vijay,et al.  An unusual inguinal "hernia"--the value of hernioscopic assessment. , 2007, Surgical laparoscopy, endoscopy & percutaneous techniques.

[9]  K. Takabe Hernia Sac Laparoscopy under Spinal Anesthesia for Evaluation of Reduced Incarcerated Inguinal Hernia , 2007, Journal of Gastrointestinal Surgery.

[10]  A. Kuthe,et al.  Die total extraperitoneale endoskopische Hernioplastik (TEP) bei Versorgung von inkarzerierten sowie irreponiblen Inguinal- und Femoralhernien , 2005 .

[11]  R. Flade-Kuthe,et al.  [Total extraperitoneal endoscopic hernioplasty (TEP) in the treatment of incarcerated and irreponible inguinal and femoral hernias]. , 2005, Zentralblatt fur Chirurgie.

[12]  F. Balsamo,et al.  Laparoscopic repair of strangulated hernias , 2005, Surgical Endoscopy And Other Interventional Techniques.

[13]  R. Sarangi,et al.  Endoscopic totally extraperitoneal repair of incarcerated inguinal hernia , 2005, Hernia.

[14]  G. Ferzli,et al.  Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia , 2004, Surgical Endoscopy And Other Interventional Techniques.

[15]  M. Al-Naami,et al.  The Use of Laparoscopy to Assess Viability of Slipped Content in Incarcerated Inguinal Hernia: A Case Report , 2003, Surgical laparoscopy, endoscopy & percutaneous techniques.

[16]  N. Scott,et al.  Laparoscopic techniques versus open techniques for inguinal hernia repair. , 2003, The Cochrane database of systematic reviews.

[17]  E. Lin,et al.  Planned reduction of incarcerated groin hernias with hernia sac laparoscopy , 2002, Surgical Endoscopy And Other Interventional Techniques.

[18]  K. Kraft,et al.  Laparoscopic transperitoneal hernia repair of incarcerated hernias: Is it feasible? , 2001, Surgical Endoscopy.

[19]  F. Weinbaum,et al.  Hernioscopic retrieval of bowel for evaluation of viability during repair of a Richter's-type incarcerated femoral hernia. , 1997, Surgical laparoscopy & endoscopy.

[20]  Y. Haraguchi,et al.  Laparoscopic approach to incarcerated inguinal hernia , 1996, Surgical Endoscopy.

[21]  W. Saye,et al.  Combined laparoscopic incarcerated herniorrhaphy and small bowel resection. , 1993, Surgical laparoscopy & endoscopy.

[22]  A. Klapper,et al.  Hernioscopy: laparoscopy via an inguinal hernia sac. , 1992, Journal of laparoendoscopic surgery.

[23]  M. Sarr,et al.  Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. , 1983, American journal of surgery.

[24]  S. Bekoe Prospective analysis of the management of incarcerated and strangulated inguinal hernias. , 1973, American journal of surgery.