A New Intraoperative Laparoscopic Examination for Detecting Inapparent Contralateral Hernia During Open Inguinal Hernia Repair

Hideto Oishi, MD, PhD, Toshihiko Mori, MD, Mimi Okano, MD, Takeshi Ishita, MD, Masayuki Ishii, MD, Takayuki Iino, MD, Hidekazu Kuramochi, MD, PhD, Shunsuke Onizawa, MD, PhD, Eiichi Hirai, MD, PhD, Mie Hamano, MD, PhD, Satoshi Katagiri, MD, PhD, Tsutomu Nakamura, MD, PhD, Tatsuo Araida, MD, PhD. Division of Gastroenterological Surgery, Department of Surgery, Yachiyo Medical Center, Tokyo Women’s Medical University

INTRODUCTION—We have devised a technique by which we can detect inapparent contralateral hernia(s) laparoscopically in patients undergoing open inguinal hernia repair without general anesthesia, and we evaluated the usefulness of the technique by reviewing cases in which the laparoscopic technique has been applied. Although prone abdominal computerized axial tomography (CAT) as a preoperative screening is generally very effective in identifying not only the main inguinal hernia but also any inapparent hernia, not all inapparent hernias are found by means of preoperative CAT. During laparoscopic inguinal hernia repair, inapparent hernia lesions are easy to find, so we select laparoscopic repair when circumstances allow. However, general anesthesia is required for laparoscopic repair, and thus it is not applicable to all patients. Some must undergo open repair.

 

METHODS AND PROCEDURES—Between January 2007 and December 2014, we repaired 688 inguinal hernias in 571 patients. Two hundred and ninety-six (51.8%) underwent laparoscopic repair, and 275 (48.2%) underwent open repair. As the years progressed, the percentage of laparoscopic repairs increased. In 2014, among 76 total patients, we performed laparoscopic repair in 59 (77.6%) and open repair in 17 (22.4 %). Because 11 of these 17 patients had serious risk factors, such a chronic obstructive pulmonary disease and/or cardiac failure, general anesthesia was contraindicated, so the repair was performed under lumbar anesthesia. Open repair is performed without pneumoperitoneum. We used a laparoscope intraoperatively in these patients to find inapparent contralateral hernias.

The laparoscopic inspection was carried out after the sac of the main hernia was cut open. A hook was inserted by its tip into the abdominal cavity via the hernia orifice and then used to lift the abdominal wall. In this way, we created a space through which we could observe the contralateral inguinal area. A laparoscope was then inserted to search for any inapparent hernia.

 

RESULTS—In 6 of 11 patients under lumbar anesthesia, obtaining a laparoscopic view of the contralateral inguinal area was quick and easy. Inapparent contralateral hernias were found by this method in 2 of 6 patients, and were repaired at the same time additionally. No complications resulted from this simple procedure.

 

CONCLUSIONS—Our intraoperative laparoscopic inspection technique appears to be very effective for detecting inapparent contralateral hernia(s) in patients undergoing open hernia repair without general anesthesia. We expect the technique to prevent the need for postoperative contralateral hernia repair in most such patients.

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