Sharma Gaurav, Schouten Jonathan A, Itani Kamal M F
Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA.
Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
J Surg Case Rep. 2017 Jan 8;2017(1):rjw228. doi: 10.1093/jscr/rjw228.
The rising use of endovascular techniques utilizing femoral artery access may increase the frequency with which surgeons face the challenge of hernia repair in reoperative groins-which may or may not include a vascular graft. We present a case where a vascular graft contributed to an acute presentation and complicated dissection, and review the literature. A 67-year-old man who had undergone prior endovascular aneurysm repair via open bilateral femoral artery access and concomitant prosthetic femorofemoral bypass, presented with an incarcerated, scrotal inguinal hernia. The graft with its associated fibrosis contributed to the incarceration by compressing the inguinal ring. Repair was undertaken via an open, anterior approach with tension-free, Lichtenstein herniorraphy after releasing graft-associated fibrosis. Repair of groin hernias in this complex setting requires careful surgical planning, preparation for potential vascular reconstruction and meticulous technique to avoid bowel injury in the face of a vascular conduit and mesh.
利用股动脉入路的血管内技术使用频率的增加，可能会使外科医生在再次手术腹股沟区面临疝修补挑战的频率上升，这种腹股沟区可能有或没有血管移植物。我们报告一例血管移植物导致急性表现和复杂解剖分离的病例，并复习相关文献。一名67岁男性，此前通过开放双侧股动脉入路接受了血管内动脉瘤修复术及同期人工股-股旁路移植术，现出现嵌顿性阴囊腹股沟疝。带有相关纤维化的移植物通过压迫腹股沟环导致了嵌顿。在松解与移植物相关的纤维化后，通过开放前路行无张力利氏疝修补术进行修复。在这种复杂情况下修复腹股沟疝需要仔细的手术规划、对潜在血管重建的准备以及精细的技术操作，以避免在有血管管道和补片的情况下损伤肠道。
