Laparoscopyc approach of complicated inguinal hernias: A challenge for the future

Abstract text (incl. references and figure legends)

CASE HISTORY

An 80 yo. male who presented to the emergency departmet with a 24 hour clinical course of vomiting and abdominal pain.

CLINICAL FINDINGS

The physical examination revealed a complicated right inguinal hernia

INVESTIGATION

In the abdominal x-ray a mild small bowel distention was found.

DIAGNOSIS

Small bowel obstruction due to a complicated inguinal hernia.

THERAPY AND PROGRESSIONS

With those results we decided to take the patient to the operating room and make a laparoscopyc aproach.
On the initial laparoscopyc exploration an indirect incarcerated inguinal hernia was found. By the time the small bowel loop was reduced into the abdominal cavity we apreciated a milimetric perforation and enteric content inside the hernial sac.
After taking a culture and cleaning the cavity, the hernial sac was plicated and a hernioraphy was performed suturing the conjoint tendon to the inguinal ligament.
The incarcerated small bowell loop wall seem to be healthy, so a direct laparoscopyc closure of the perforation was performed .
The postoperative evolution was good, been able to restart the oral intake at the 3rd postoperatoive day. The patient was discharged in postoperative day 6.

COMENTS

The laparoscopic aproach of inguinal hernias repair is a well known technique by most of the surgeons,but it haven´t become a commonly applied technique in the context of an emergency surgery, despite of its advanteges, such as the direct visuallization of the bowell during all the lenght of the surgery.
As seen in this case, in the hands of an experienced surgeon; even the complicated cases can be resolved by this aproach, avoiding the complications of a laparotomy such as: pain, surgical site infections and incisional hernias.
We belive that the laparoscopyc aproach of hernias in the contex of emergency surgery sholud became one of the skills of every surgeon.

REFERENCES

Öberg S, Rosenberg J. Contemporary inguinal hernia management. BJS, 2022,109, 244–246

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