Thalheimer Andreas, Vonlanthen Rene, Ivanova Silviya, Stoupis Christoforos, Bueter Marco
Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland; Department of Surgery, Spital Männedorf, Männedorf, Switzerland.
Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland.
Int J Surg Case Rep. 2021 Nov;88:106532. doi: 10.1016/j.ijscr.2021.106532. Epub 2021 Oct 18.
Inguinal hernia repair is a very frequent operation in general and visceral surgery worldwide. The laparo-endoscopic approaches such as TAPP have gained increasing acceptance among specialists and many consider them as standard of care due to perioperative safety and excellent postoperative results. Knowledge of specific complications after minimally invasive inguinal hernia surgery, however, is important for the successful management of these patients.
We herein present the case of a 75-year-old female patient who electively underwent laparoscopic repair of combined inguinal and femoral hernia. During the postoperative course a small bowel obstruction occurred requiring emergency re-laparoscopy revealing a preperitoneal herniation of small bowel through a peritoneal defect.
Small bowel obstruction due to preperitoneal herniation of small bowel through a peritoneal defect after laparoscopic hernia repair is extremely rare. In such cases, emergency laparoscopic revision is necessary to avoid bowel ischaemia. Adequate closure of the peritoneum during the primary procedure along with the necessary attention to detail seems mandatory to avoid preperitoneal herniation after TAPP.
Inadequate peritoneal closure after TAPP may lead to preperitoneal herniation of the small bowel leading to postoperative intestinal obstruction. All hernia surgeons should be aware of this rare, but potentially life-threatening complication and should close all peritoneal defects with greatest care and accuracy.
腹股沟疝修补术是全球普通外科和腹部外科中非常常见的手术。诸如经腹腹膜前疝修补术（TAPP）等腹腔镜 - 内镜手术方法在专家中越来越被接受，并且由于围手术期安全性和出色的术后效果，许多人将其视为标准治疗方法。然而，了解微创腹股沟疝手术后的特定并发症对于成功管理这些患者很重要。
我们在此介绍一位75岁女性患者的病例，该患者选择性地接受了腹腔镜下腹股沟疝和股疝联合修补术。术后过程中发生了小肠梗阻，需要紧急再次腹腔镜检查，结果发现小肠通过腹膜缺损发生了腹膜前疝。
腹腔镜疝修补术后小肠通过腹膜缺损发生腹膜前疝导致的小肠梗阻极为罕见。在这种情况下，紧急腹腔镜翻修术是必要的，以避免肠缺血。在初次手术过程中充分关闭腹膜并对细节给予必要关注，对于避免TAPP术后腹膜前疝似乎是必不可少的。
TAPP术后腹膜关闭不当可能导致小肠腹膜前疝，进而导致术后肠梗阻。所有疝外科医生都应意识到这种罕见但可能危及生命的并发症，并应极其小心和准确地关闭所有腹膜缺损。
