Hernioscopy: a useful technique for the evaluation of incarcerated hernias that retract under anaesthesia

Hernia - 2007
G. Morris-Stiff1,2, A. Hassn1
1Department of Surgery, Princess of Wales Hospital, Bridgend, UK
2Rhondda Cynon Taf, UK

Tóm tắt

The diagnosis of strangulation within an incarcerated abdominal-wall hernia is not always possible preoperatively. In approximately 1% of cases of incarcerated hernias, a strangulated viscus will reduce spontaneously following administration of muscle relaxants during induction of anaesthesia, and the surgeon has to perform an exploratory laparotomy. The aim of this study was to report the use of hernioscopy to inspect intra-abdominal contents and thus prevent unnecessary laparotomy. The case notes of all patients undergoing hernioscopy for incarcerated hernias that reduced spontaneously during induction of anaesthesia, skin incision, or prior to evaluation of sac contents were reviewed. Hernioscopy is performed following insertion of a 10-mm port through the hernia sac. Standard insufflation with carbon dioxide is performed, maintaining an intra-abdominal pressure of 10–12 mmHg following which the laparoscope is inserted and a diagnostic examination performed. Following completion of hernioscopy, the laparoscope is withdrawn, the pneumoperitoneum released, and the hernia repaired in a conventional manner using a tension-free technique. Five patients underwent hernioscopy for the evaluation of incarcerated hernias that had reduced spontaneously prior to inspection of sac contents. There were four men with indirect inguinal hernias and one woman with an incarcerated femoral hernia. The hernioscopy of the four men was unremarkable and they went home the following day. The female patient had blood within the peritoneal cavity arising from the upper abdomen and underwent laparotomy and splenectomy. She made an unremarkable recovery and was discharged on postoperative day 7. Hernioscopy is a simple and useful technique that can be performed by surgeons familiar with laparoscopic procedures such as appendicectomy and cholecystectomy.

Từ khóa


Tài liệu tham khảo

Silen W, Hein MF, Goldman L (1962) Strangulation obstruction of the small intestine. Arch Surg 85:121–129

Sarr MG, Buckley GB, Zuidema GD (1973) Preoperative recognition of intestinal strangulation obstruction. Am J Surg 145:178–182

Bekoe S (1973) Prospective analysis of the management of incarcerated and strangulated hernias. Am J Surg 126:665–668

Shalita AH, Chamberlain BE, Webb WR (1976) Current status of diagnosis and management of strangulation obstruction of the small bowel. Am J Surg 132:299–303

Hjaltason E (1981) Incarcerated hernia. Acta Chir Scand 147:263–267

Pollak R (1989) Strangulating external hernia. In: Nyhus LM, Condon RE (eds) Hernia. JB Lippincott, Philadelphia, pp 273–284

Watson SD, Saye W, Hollier PA (1993) Combined laparoscopic incarcerated herniorrhaphy and small bowel resection. Surg Laparosc Endosc 3:106–108

Lavonius MI, Ovaska J (2000) Laparoscopy in the evaluation of the incarcerated mass in groin hernia. Surg Endosc 14:488–489

Al-Naami MY, Al-Shawi JS (2003) The use of laparoscopy to assess viability of slipped content in incarcerated inguinal hernia: a case report. Surg Laparosc Endosc Percutan Tech 13:292–294

Ishihara T, Kubota K, Eda N, Ishibashi S, Haraguchi Y (1996) Laparoscopic approach to incarcerated inguinal hernia. Surg Endosc 10:1111–1113

Liao K, Ramirez J, Carryl S, Shaftan GW (1997) A new approach in the management of incarcerated hernia. Emergency laparoscopic hernia repair. Surg Endosc 11:944–945

Leibl BJ, Schmedt CG, Kraft K, Kraft B, Bittner R (2001) Laparoscopic transperitoneal hernia repair of incarcerated hernias: is it feasible? Results of a prospective study. Surg Endosc 15:1179–1183

Kaiwa Y, Namike K, Matsumoto H (2003) Laparoscopic relief of reduction en masse of incarcerated inguinal hernia. Surg Endosc 17:352

Ferzli G, Shapiro K, Chaudry G, Patel S (2004) Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia. Surg Endosc 18:228–231

Kaya M, Huckstedt T, Schier F (2006) Laparoscopic approach to incarcerated inguinal hernia in children. J Pediatr Surg 41:567–569

Rebuffat C, Galli A, Scalambra MS, Balsamo F (2006) Laparoscopic repair of strangulated hernia. Surg Endosc 20:131–134

Saggar VR, Sarangi R (2004) Endoscopic totally extraperitoneal repair of incarcerated inguinal hernia. Hernia 9:120–124

Binderow SR, Klapper AS, Bufalini B (1992) Hernioscopy: laparoscopy via an inguinal hernia sac. J Laparosndosc Surg 2:229–233

Norman J, McAllister E, Wasselle J (1992) Laparoscopy through an inguinal hernia for diagnosis of intraperitoneal pathology. J Laparoendosc Surg 1:339–341

Kneessy K, Weinbaum F (1997) Hernioscopic retrieval of bowel for evaluation of viability during repair of a Richter’s-type incarcerated femoral hernia. Surg Laparosc Endosc 7:171–172

Timsit G (1997) Technique and indications. Int Surg 82:105–106

Lin E, Wear K, Tiszenkel HI (2002) Planned reduction of incarcerated groin hernias with hernia sac laparoscopy. Surg Endosc 16:936–938

Serreyn RF, Schoofs PR, Baetens PR, Vandekerckhove D (1986) Laparoscopic diagnosis of mesenteric venous thrombosis. Endoscopy 18:240–250

Iberti TJ, Salky BA, Onofrey D (1989) Use of bedside laparoscopy to identify ischaemia in postoperative cases of aortic reconstruction. Surgery 105:686–689

Wulkan ML, Wiener ES, VanBalen N, Vescio P (1996) Laparoscopy through the open ipsilateral sac to evaluate presence of contralateral hernia. J Pediatr Surg 31:1174–1176

Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetz CA, Brandt ML (1997) Meta-analysis of the risk of metachronous hernia in infants and children. Am J Surg 174:741–744

Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetiz C, Brandt ML (1998) Laparoscopic evaluation of the pediatric inguinal hernia—a meta-analysis. J Pediatr Surg 33:874–879

Lewis DC, Moran CG, Vellacott KD (1989) Inguinal hernia repair in the elderly. J R Coll Surg Edinb 34:101–103

Deysine M, Grimson R, Soroff HS (1987) Herniorrhaphy in the elderly. Benefits of a clinic for the treatment of external abdominal wall hernia. Am J Surg 153:387–391

Stephens BJ, Rice WT, Koucky CJ, Gruenberg JC (1992) Optimal timing of elective indirect inguinal hernia repair in healthy children: clinical consideration for improved outcome. World J Surg 16:952–957

Thông tin
Thông tin xuất bản

Hernia

Thông tin tác giả