Ginestà Cesar, Saavedra-Perez David, Valentini Mauro, Vidal Oscar, Benarroch Guerson, García-Valdecasas Juan Carlos
Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Surg Laparosc Endosc Percutan Tech. 2013 Jun;23(3):334-6. doi: 10.1097/SLE.0b013e31828e3776.
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.
我们描述了首例腹腔镜辅助下经完全腹膜外疝修补术联合肠切除术治疗绞窄性里脱氏股疝的临床病例。患者为一名94岁女性，因急性小肠梗阻的症状和体征入住急诊室。仅在初次探查性腹腔镜检查时才确诊为绞窄性左里脱氏股疝。通过脐下12mm套管针切口进入腹腔，在耻骨上和右腹侧使用两个5mm腹腔镜端口辅助进行腹膜外补片放置。恢复腹腔镜检查后，进行了肠段切除并一期吻合。患者恢复顺利，无并发症，术后第4天出院。在我们这个特殊病例中，经完全腹膜外途径进行急性疝修补术是成功的。然而，在急诊环境下开展研究之前，必须考虑诸如腹腔镜手术经验、仔细的患者选择和正确的术前诊断等因素。
