Laparoscopic repair of irreducible femoral hernia containing the fallopian tube alone: a case report

Transabdominal preperitoneal versus hybrid procedures for treating irreducible inguinal hernias: A retrospective controlled study

BACKGROUND

Inguinal hernia is a common condition; however, irreducible inguinal hernias are rare. In this retrospective study, two laparoscopic procedures for irreducible inguinal hernia were compared.

MATERIALS AND METHODS

The study cohort comprised 88 patients who had undergone laparoscopic repair of primary irreducible inguinal hernias between 1 June 2011 and 31 December 2019. The patients were retrospectively divided into Hybrid (Group H) and Standard Transabdominal Preperitoneal (TAPP) Groups (Group S). Patient characteristics, hernia details, and intraoperative and postoperative complications were compared between study groups.

RESULTS

There were no significant differences between the two groups in baseline characteristics, including age, sex, body mass index, hernia type, operation time, hospital stay, cost, and duration of follow-up. No recurrence or surgical site infection occurred in either group. There were no significant differences between the two groups in incidence of spermatic vessel injury (0% vs. 2.04%, P = 0.370), vas deferens injury (0% vs. 6.12%, P = 0.116), epigastric vessels injury (0% vs. 4.08%, P = 0.202), scrotal hematoma (7.69% vs. 2.04%, P = 0.206), dysuria (5.13% vs. 8.16%, P = 0.575), fever (17.95% vs. 16.32%, P = 0.841), seroma (25.64% vs. 32.65%, P = 0.474), chronic pain (0% vs. 2.04%, P = 0.370), sensation of a foreign body (2.56% vs. 2.04%, P = 0.870), or pain on ejaculation (0% vs. 2.04%, P = 0.370). The incidence of acute pain was higher in Group H than in Group S (43.59% vs. 8.16%, P = 0.000).

CONCLUSION

The hybrid TAPP procedure is a safe and feasible means of treating irreducible inguinal hernias. Though it is associated with a higher incidence of postoperative acute pain than the standard TAPP procedure, it may have advantages in avoiding injuries to the vas deferens and spermatic vessels.

Femoral hernia containing the right fallopian tube: chronic pain with menstruation

Femoral hernias represent less than 10% of groin hernias and appear mainly in adult women; incarceration is more usual than in other hernias. Content found within the sac is commonly small bowel or omentum. Other anatomical structures, such as appendix, bladder, Meckel's diverticulum, ectopic testis, stomach and gynaecological organs are extremely unusual. A 48-year-old woman presented with intense right groin pain over 48 hours. Her past medical history revealed periodical moderate right groin pain coincident with her menstrual cycles, usually self-limited. No abdominal symptoms or fever were present. On physical examination, an incarcerated right femoral hernia was suspected. Subsequently abdominal ultrasound revealed a right femoral hernia containing an echogenic structure with conserved vascularisation. The patient underwent an emergency surgery. During the procedure the right fallopian tube and several small cysts were discovered as the hernia sac contents. As no ischaemic signs were observed, and the sac was sutured and reduced. Femoral hernioplasty was accomplished with polypropylene mesh. The postoperative course was uneventful and the patient was discharged within 24 hours. After an exhaustive literature review, we have found few cases reporting the presence of fallopian tube in adult women with femoral hernia, but none described a recurrent groin pain coinciding with menstruation, as in this case.