Masaki Wakasugi, Yujiro Nakahara, Masaki Hirota, Takashi Matsumoto, Hiroyoshi Takemoto, Ko Takachi, Kiyonori Nishioka, Satoshi Oshima. Department of Surgery, Kinki Central Hospital
To evaluate the efficacy of single-incision laparoscopic surgery for totally extraperitoneal repair (SILS-TEP) of incarcerated inguinal hernia.
Patients and Methods:
A retrospective analysis of 14 patients undergoing SILS-TEP for incarcerated hernia from May 2016 to August 2017 at Kinki Central Hospital was performed.
SILS-TEP was contraindicated for the following conditions in our hospital: a history of radical prostatectomy; a small indirect inguinal hernia in a young patient; and unsuitable for general anesthesia.
Laparoscopic abdominal exploration through a single, 2.5-cm, intraumbilical incision was performed. The incarcerated hernia content was gently retracted from the hernia sac into the abdominal cavity. In some cases, simultaneous manual compression on the incarcerated hernia from the body surface was required. If no bowel resection was needed, a standard SILS-TEP using mesh was performed following laparoscopic abdominal exploration and incarcerated hernia reduction. If bowel resection was required, inguinal hernia repair using mesh was not performed to avoid postoperative mesh infection, and two-stage SILS-TEP was performed 2-3 months after the bowel resection.
Results: Fourteen patients (11 men, 3 women) with irreducible inguinal hernias, including 11 with unilateral hernias and 3 with bilateral hernias, underwent surgery. The patients’ median age was 74 years (range, 38–83 years), and median BMI was 23.5 kg/m2 (range, 18.8–30.5 kg/m2). Of the 14 patients, 7 had acute incarceration, and 7 had a chronic irreducible hernia. Seven patients with acute incarcerated hernias underwent emergency surgery, and two of the seven patients needed single-incision laparoscopic partial resection of the ileum, followed by two-stage SILS-TEP. Twelve patients, excluding two patients who required single-incision laparoscopic partial resection of the ileum, underwent laparoscopic exploration with hernia reduction followed by SILS-TEP. One case of chronic incarceration out of the twelve patients who underwent SILS-TEP after hernia reduction required conversion to Kugel patch repair. The median operative times were 102 min (range 52-204 min) for unilateral hernias and 165 min (range 83-173 min) for bilateral hernias. The median blood loss was minimal (range 0-177 ml). The median postoperative hospital stay was 1 day (range 1-3 days). The median follow-up period was 7 months (range 1-15 months). A seroma developed in 25% (3/12) of patients and was managed conservatively. No other major complications or hernia recurrence were noted during the follow-up period.
Conclusions: SILS-TEP, which offers good cosmetic results, could be safely performed for incarcerated inguinal hernia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86290
Program Number: P005
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster