Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, 52621 Tel-Hashomer, Israel.
Surg Endosc. 2010 Aug;24(8):1815-8. doi: 10.1007/s00464-009-0857-9. Epub 2010 Jan 9.
The traditional open approach to incarcerated inguinal hernia has several drawbacks including difficulty avoiding tension in the swollen and edematous tissues leading to a higher recurrence rate, possible contamination of the mesh if it is implanted in an area of bowel strangulation, and proper evaluation of whether ischemic bowel requires resection or not, which may mandate laparotomy. This study aimed to evaluate an approach that combines intraperitoneal laparoscopic exploration with hernia reduction and total extraperitoneal (TEP) repair of the hernia.
An exploratory laparoscopy is performed. The incarcerated content is gently retracted into the abdominal cavity and inspected. If no resection is needed, the gas is deflated, the umbilical trocar is removed, and the preperitoneal space is accessed with a Hasson trocar inserted behind the rectus muscle toward the pelvis. Two additional 5-mm trocars are inserted into the preperitoneal space in the lower midline. A standard TEP repair with mesh is performed.
Between 2005 and 2008, 15 patients underwent laparoscopic exploration for incarcerated inguinal hernia followed by TEP repair. Of the 15 patients, 8 had acute incarceration and 7 had chronic irreducible hernia. Reduction of the incarcerated content was straightforward, and no bowel resection was needed. No major complications or wound or mesh infections occurred.
The combined laparoscopic approach offers a solution to incarceration of inguinal hernias while taking advantage of each separate approach. The first part of the procedure enables easy reduction of the incarcerated content and assessment of its viability. The second part enables a simple and standard repair, similar to that for an elective case. If bowel necrosis is suspected preoperatively, an open anterior approach should be taken to avoid possible intraabdominal contamination.
传统的开放式腹股沟疝嵌顿治疗方法存在一些缺点，包括难以避免肿胀和水肿组织的张力，导致更高的复发率；如果疝囊在肠绞窄区域植入，可能会导致网片污染；以及无法正确评估缺血性肠是否需要切除，这可能需要开腹手术。本研究旨在评估一种结合腹腔镜探查、疝复位和完全腹膜外（TEP）修补的方法。
进行探查性腹腔镜检查。将嵌顿内容物轻轻缩回腹腔并进行检查。如果不需要切除，则放气，移除脐部套管针，并使用 Hasson 套管针从腹直肌后方朝向骨盆进入腹膜前间隙。在下腹部中线上再插入两个 5mm 的套管针。进行标准的 TEP 修补和网片固定。
2005 年至 2008 年间，15 例嵌顿性腹股沟疝患者接受了腹腔镜探查，随后进行了 TEP 修补。15 例患者中，8 例为急性嵌顿，7 例为慢性不可复性疝。嵌顿内容物的复位很顺利，不需要进行肠切除。没有发生重大并发症、伤口或网片感染。
联合腹腔镜方法为腹股沟疝嵌顿提供了一种解决方案，同时利用了每种单独方法的优势。该手术的第一部分可轻松复位嵌顿内容物并评估其活力。第二部分可进行简单标准的修补，类似于择期手术。如果术前怀疑肠坏死，应采用开腹前入路，以避免可能的腹腔内污染。
