Laparoscopic management of acutely incarcerated femoral hernia

The Utility of Minimally Invasive Surgery in the Emergency Management of Femoral Hernias: A Systematic Review

Background: Femoral hernias are a relatively rare type of hernia but have a high complication rate, with a high proportion either presenting as an emergency or requiring emergency management. Minimal access surgery has been shown to be safe, with good results, in an elective setting, but there is little published evidence of its utility in an emergency. Methods: A systematic review was conducted searching PubMed, OVID, Embase, and Cochrane reviews for ((Femoral hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). Results: 286 manuscripts were identified of which 33 were relevant. 24 were individual case reports, 3 case series, 4 cohort studies or case control series, and 2 high level reviews of National registers. Conclusion: Minimal access surgery can avoid an unnecessary laparotomy for the assessment of hernial contents, especially via a TAPP approach. Minimal access repair of femoral hernias as an emergency is feasible and can be done safely with results similar to open surgery but good quality evidence is lacking.

Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study

PURPOSE

The aim of this study is to compare the postoperative results, in terms of complications and recurrence, between the anterior and open preperitoneal approaches in emergency femoral hernia.

METHODS

This bi-centric retrospective cohort study included patients who underwent emergency femoral hernia repair between January 2010 and December 2018. Postoperative complications and recurrence were analyzed comparing anterior and open preperitoneal approaches. The predictors of complications, mortality and recurrence were investigated using multivariate logistic regression.

RESULTS

A total of 204 patients met the inclusion criteria. Open anterior approach was performed in 128 (62.7%) patients and open preperitoneal was performed in 76 (37.3%). Open preperitoneal approach was associated with lower rates of recurrence (P = 0.033) and associated midline laparotomies (P = 0.006). Multivariable analysis identified patients with chronic nephropathy (OR, 3.801; 95%CI, 1.034-13.974; P = 0.044), preoperative bowel obstruction (OR, 2.376; 95%CI, 1.118-5.047; P = 0.024) and required midline laparotomy (OR, 12.467; 95%CI, 11.392-102.372; P = 0.030) as risk factors for complications and ASA ≥ III (OR, 7.820; 95%CI, 1.279-47.804; P = 0.026), COPD (OR, 5.064; 95%CI, 1.188-21.585; P = 0.028), necrotic contents (OR, 36.968; 95%CI, 4.640-294.543; P = 0.001), and required midline laparotomy (OR, 11.047; 95%CI, 1.943-62.809; P = 0.007). as risk factors for 90-day mortality. Male gender (OR, 4.718; 95%CI, 1.668-13.347; P = 0.003) and anterior approach (OR, 5.292; 95%CI, 1.114-25.149; P = 0.036) were risk factors for recurrence.

CONCLUSION

Open preperitoneal approach may be superior to anterior approach in the emergency setting because it can avoid the morbidity of associated midline laparotomies, with a lower long-term recurrence rate.

Laparoscopic approach in emergency for the treatment of acute incarcerated groin hernia: a systematic review and meta-analysis

PURPOSE

Minimally invasive approach for acute incarcerated groin hernia repair is still debated. To clarify this debate, a literature review was performed.

METHODS

Search was performed in PubMed, Embase, Scopus, Web of Science, and Cochrane databases, founding 28,183 articles.

RESULTS

Fifteen articles, and 433 patients were included (16 bilateral hernia, range 3-8). Three hundred and eighty-eight (75.3%) and 103 patients (22.9%) underwent transabdominal preperitoneal and totally extraperitoneal repair, respectively, and in 5 patients, the defect was buttressed with broad ligament (1.1%) (not specified in 3 patients). Herniated structures were resected in 48 cases (range 1-9). Intraoperative complications and conversion occurred in 4 (range 0-1) and 10 (range 0-3) patients, respectively. Mean operative time and hospital stay ranged between 50 and 147 min, and 2 and 7 days, respectively. Postoperative complications ranged between 1 and 19. Five studies compared laparoscopic and open approaches (163 and 235 patients). Herniated structures were resected in 19 (11.7%) and 42 cases (17.9%) for laparoscopic and open approach, respectively (p = 0.1191). Intraoperative complications and conversion occurred in one (0.6%) and 5 (2.1%) patients (p = 0.4077), and in two (1.2%) and 19 (8.1%) patients (p = 0.0023), in case of laparoscopic or open approach, respectively. Mean operative time and hospital stay were 94.4 ± 40.2 and 102.8 ± 43.7 min, and 4.8 ± 2.2 and 11 ± 3.1 days, in laparoscopic or open approach, respectively. Sixteen (9.8%) and 57 (24.3%) postoperative complications occurred.

CONCLUSION

Laparoscopy seems to be a safe and feasible approach for the treatment of acute incarcerated groin hernia. Further studies are required for definitive conclusions.

Laparoscopic approach as a safe and effective option for incarcerated femoral hernias

INTRODUCTION

The laparoscopic approach for elective femoral herniorrhaphy is well established. However, femoral hernias often present as incarcerations and require emergency repair surgery, mainly using the open approach. This study aimed to retrospectively analyze the efficacy of the laparoscopic approach for incarcerated femoral hernias.

METHODS

Data of patients who underwent emergency surgery for incarcerated femoral hernia between April 2016 and August 2021 were retrospectively analyzed. Laparoscopy was performed whenever possible; however, conversion to an open approach remained a fallback option for when laparoscopic repair was not possible. In laparoscopic repair, incarcerated femoral hernias reduced using traction, water pressure, and preperitoneal methods. Data of patients who underwent open repair and laparoscopy were then compared.

RESULTS

During the observation period, 20 patients underwent emergency surgery for incarcerated femoral hernia. Eleven patients subsequently underwent repair using a laparoscopic approach, and eight underwent repair using an open approach. Only one patient underwent intestinal resection without hernia repair due to perforated bowel. Operative time for laparoscopic repair was longer. Mesh repair was performed in 18 patients. Four patients each in the laparoscopic repair and open group required intestinal resection.

CONCLUSION

Incarcerated femoral hernias can be safely repaired using the laparoscopic approach.

A novel technique of laparoscopic reduction of incarcerated internal supravesical hernia via peritoneal incision: A case report

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There is no golden standard for surgical procedure for internal supravesical hernia.

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There are previous reports of surgery by open laparotomy, laparoscopy and anterior approach.

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Various methods for bowel reduction have been described for other hernias, but none by peritoneal incision.

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The incarcerated small bowel was safely reduced by peritoneal incision in our case.

Introduction

Laparoscopic reduction techniques for internal supravesical hernia have not been discussed much in literature.

Case presentation

A 90-year old woman was admitted for symptoms of intestinal obstruction. She was diagnosed with small bowel strangulation by CT scan and laparoscopy was performed. Laparoscopy revealed a mass medial to the medial inguinal fold with tightly incarcerated small bowel. The bowel could not be reduced by traction or external compression, and required incision of the hernia ring. The tight incarceration posed a risk of bowel injury and so we performed peritoneal incision in a similar manner to the TAPP approach for loosening and precise incision of the hernia ring. The bowel was successfully reduced and the hernia was repaired by partial sac resection.

Discussion

Surgical methods as well as reduction technique were reviewed from previous literature. Procedures with open laparotomy, laparoscopy and anterior approach have been described, but details of reduction were not seen in many of these reports. Various methods have been described for bowel reduction in other hernias, but none involving peritoneal incision. This is the first report describing bowel reduction via the peritoneal incision technique.

Conclusion

Internal supravesical hernia may pose difficulty in bowel reduction, but the peritoneal incision technique allows safe incision of the hernia ring under laparoscopic situations.

Mini-mesh and Lichtenstein repair compared with a modified Kugel technique for femoral hernia: a randomised controlled trial

INTRODUCTION

A modified Kugel patch is more expensive than ordinary mesh and demands a wide dissection of the preperitoneal space in femoral hernia repair. We therefore adopted a novel method using mini-mesh and a Lichtenstein repair. This study compared mini-mesh and Lichtenstein repair with a modified Kugel technique in patients with a primary unilateral femoral hernia.

METHODS

Patients with unilateral femoral hernia were assigned randomly to undergo mini-mesh and Lichtenstein repair (M group) or modified Kugel repair (K group), followed-up at one week, three months, one year and two years. Demographics, hernia characteristics and operative outcomes of two groups were analysed.

RESULTS

A total of 48 patients in the K group and 49 participants in the M group completed follow-up. The operation time for the M group (68.6 ± 13.4 minutes) was significantly shorter than that of the K group (80.6 ± 10.1 minutes; p=0.030). There was no significant difference between the two groups for chronic pain, foreign body feeling and quality of life, and no recurrence occurred.

CONCLUSIONS

Mini-mesh and Lichtenstein repairs have reasonable results in the patients with femoral hernia in this study, with a reduced operation time compared with a modified Kugel repair. The trial was registered with the Chinese Clinical Trials Registry: ChiCTR1900022264.

Laparoscopic transabdominal preperitoneal repair of strangulated femoral hernia: Superiority of an unusual emergency surgical approach due to a case

Introduction

Inguinal hernia repair is one of the most common operations of general surgery. In order to avoid complicated and urgent cases, performing such operations electively is generally accepted. Otherwise, unforeseen emergency surgical situations accompanied by incarceration and strangulation may occur.

Case presentation

In this article, we present a 45-year-old female patient with strangulated femoral hernia repair that we performed using the laparoscopic transabdominal preperitoneal method, unlike other conventional methods.

Discussion

Early diagnosis and elective surgical treatment have an important role in hernia surgery, especially due to increased morbidity and mortality. Laparoscopic inguinal hernia repair has developed in the recent years as a prominent method and nowadays it is performed much easier than the open method even in urgent and challenging cases.

Conclusion

The transabdominal preperitoneal method has superiority over the conventional method in terms of ensuring that intestinal loop is visible during the strangulated femoral hernia repair and that the feeding of the intestine is intact.

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The TAPP method has superiority over the conventional method in terms of ensuring that intestinal loop is visible during the strangulated femoral hernia repair.

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This method allows us also the possibility of diagnostic laparoscopy for the emergency cases.

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Direct visualization of the incarcerated or strangulated organ and, if necessary, ability to perform resection laparoscopically are significant advantages of this technique.

Totally extra-peritoneal repair for acute incarcerated femoral hernia with intestinal obstruction

INTRODUCTION

Femoral hernias frequently present with incarceration, resulting in obstruction and strangulation. Laparoscopic groin hernia repairs have been shown in the elective setting to be an effective alternative to open repair. Acute incarceration of groin hernia with obstruction, though previously seen as a relative contraindication, has been increasingly repaired with minimally invasive techniques, with the potential benefit of avoiding the morbidity associated with a laparotomy.

PRESENTATION OF CASE AND DISCUSSION

We describe a case of an acutely incarcerated femoral hernia with intestinal obstruction that was repaired using the totally extra-peritoneal approach. A releasing incision was performed to facilitate reduction of hernia prior to mesh repair. Diagnostic laparoscopy through a separate incision was then performed.

CONCLUSION

This modification of the TEP repair technique for the acutely incarcerated and obstructed femoral hernia serves to minimise potential contamination by keeping the pre-peritoneal plane strictly separate from the intra-peritoneal space.

An alternative anterior tension free preperitoneal patch technique by help of the endoscope for femoral hernia repair

BACKGROUND

Femoral hernias are relatively uncommon and have a higher risk for strangulation and incarceration. We introduce an alternative anterior tension free inlay patch technique by help of the endoscope for femoral hernia repair.

METHOD

Characteristics of patients undergoing femoral hernia repair between March 2006-April 2011 and description of the surgical technique is presented.

RESULTS

We analyzed our experience with this technique in 26 consecutive patients with femoral hernias (1 bilateral, 15 right, 10 left femoral hernia) in 5 year period. Seven of these 26 femoral hernias were recurrent and 2 of them were concomitant with inguinal hernia. Mean operation time was 30.0 ± 12.1 min. Seroma was seen in 2 patients at postoperative 1st week. There were no; hematoma, wound infection and separation of wound edges and early recurrence at postoperative 1st week and 1st month. The mean follow up period was 41.8 ± 18.2 months. All of 22 patients who were contacted were satisfied with the operation. There was no recurrence, chronic pain and foreign body feeling in any patient at the end of the follow-up period.

CONCLUSION

This feasible and safe alternative anterior inlay patch repair might be used in all femoral hernias with the exception of the ones requiring intestinal resection.

Laparoscopic total extraperitoneal repair in femoral hernia without fixation of the mesh

BACKGROUND AND OBJECTIVES

We report on laparoscopic total extraperitoneal repair without fixation of mesh for femoral hernia in 6 patients.

METHODS

During a 3-year period, laparoscopic total extraperitoneal repair of femoral hernia was performed without mesh fixation in 6 patients. The recurrence rate, pain scores, hospital stay, and other morbidity parameters were noted. Pain scores were 1=no pain, 2=mild pain, 3=moderate pain, 4=severe pain, and 5=intolerable pain.

RESULTS

All 6 patients were females and had unilateral hernias. Mean age was 33.8+/-18.6 years, and follow-up ranged from 12 months to 36 months. Four patients were operated on while under spinal anesthesia, and 2 patients were operated on while under general anesthesia. Mean operating time was 29.2+/-10.7 minutes. The mean pain scores 24 hours and the first week after operation were, respectively, 2.33+/-0.52 and 1.33+/-0.52. Mean hospital stay was 1.17+/-0.41 days, and mean days to resumption of normal activities were 8.5+/-2.1 days. No patient had urinary retention or seroma formation in the postoperative period. At follow-up, no hernia had recurred.

CONCLUSIONS

Laparoscopic femoral hernia repair without fixing the mesh is safe, feasible, and associated with minimal morbidity and recurrence rates.