University Hospital of Araba. Sede Santiago Apóstol, Vitoria, Alava, Spain.
CRSLS. 2021 Jun 8;8(2). doi: 10.4293/CRSLS.2020.00098. eCollection 2021 Apr-Jun.
Less than 300 cases of a De Garengeot's hernia have been published. This rare femoral hernia with the vermiform appendix included appears almost exclusively on the right side, mainly in females, and it generally debuts as an incarcerated femoral hernia. Although most of the times there is a concomitant appendicitis, clinical signs of peritonitis are absent. The wide use of radiologic exams has not favored its preoperative diagnosis, but been usually found incidentally during a surgical emergency. The best surgical approach to a De Garengeot's hernia is not totally defined and many critical questions still remain unanswered. Open surgery is considered the standard treatment procedure, but since the emergence of laparoscopy for incarcerated hernias, this is certainly an option. We report the successful laparoscopic management of an 83-year-old woman who had been operated on her right inguinal hernia, with a Rutkow-Robbins' technique, 4 months earlier. She had noticed the protrusion of a lump in her right inguinal region for 2 months. Radiological studies were not conclusive. With a miss diagnosis of a recurrent incarcerated inguinal hernia, a minimal invasive endoscopic approach was performed. A representative case of this fully laparoscopic TAPP procedure is presented. The patient made an uninterrupted recovery. She left the hospital the day after in a stable condition and has enjoyed good health since. A fully laparoscopic TAPP approach seems perfectly safe and feasible to treat this entity, and could be considered the first line alternative when enough expertise is available.
仅有不到 300 例 De Garengeot 疝被报道。这种罕见的带阑尾的股疝几乎只出现在右侧，主要发生在女性，通常首发为嵌顿股疝。尽管大多数情况下伴有阑尾炎，但没有腹膜炎的临床征象。虽然影像学检查广泛应用，但并没有有利于其术前诊断，通常是在外科急症中偶然发现。De Garengeot 疝的最佳手术方法尚未完全确定，许多关键问题仍未得到解答。开放手术被认为是标准的治疗方法，但自从腹腔镜用于治疗嵌顿疝以来，这肯定是一种选择。我们报告了一例成功的腹腔镜治疗，患者为 83 岁女性，4 个月前曾因右侧腹股沟疝接受 Rutkow-Robbins 技术手术。她注意到右侧腹股沟区有肿块突出 2 个月。影像学研究没有明确结果。误诊为复发性嵌顿性腹股沟疝，行微创内镜治疗。介绍了一例完全腹腔镜 TAPP 手术的典型病例。患者恢复顺利。她在稳定状态下于术后次日出院，此后身体状况良好。完全腹腔镜 TAPP 方法治疗这种疾病似乎是安全可行的，并且在有足够专业知识的情况下，可以考虑作为一线治疗方法。
