ABSTRACT

Background and Objectives: Less than 300 cases of a De Garengeot’s hernia have been published. This rare femoral hernia with the vermiform appendix included appears almost exclusively on the right side, mainly in females, and it gen- erally debuts as an incarcerated femoral hernia. Although most of the times there is a concomitant appendicitis, clinical signs of peritonitis are absent. The wide use of radiologic exams has not favored its preoperative diagnosis, but been usually found incidentally during a surgical emergency. The best surgical approach to a De Garengeot’s hernia is not totally defined and many critical questions still remain unanswered. Open surgery is considered the standard treatment procedure, but since the emergence of laparoscopy for incarcerated hernias, this is certainly an option.

Methods: We report the successful laparoscopic management of an 83-year-old woman who had been operated on her right inguinal hernia, with a Rutkow-Robbins’ technique, 4 months earlier. She had noticed the protrusion of a lump in her right inguinal region for 2 months. Radiological studies were not conclusive. With a miss diagnosis of a recurrent incarcerated inguinal hernia, a minimal invasive endoscopic approach was performed. A representative case of this fully laparoscopic TAPP procedure is presented.

Results: The patient made an uninterrupted recovery. She left the hospital the day after in a stable condition and has enjoyed good health since.

Conclusion: A fully laparoscopic TAPP approach seems perfectly safe and feasible to treat this entity, and could be con- sidered the first line alternative when enough expertise is available.

Key Words: De Garengeot’s Hernia, TAAP, Laparoscopic Hernioplasty, Appendix, Femoral Hernia.

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Department of Surgery, Veterans Affairs Central Iowa Health Care System, Des Moines, IA, USA (Dr. Staab). Surgery Residency Program of the Iowa Methodist Medical Center, Des Moines, IA, USA (Dr. Welander).

ABSTRACT

Minimally invasive surgical technology is changing the management of spigelian hernias. In addition to open repairs, laparoscopic transabdominal repairs as well as laparoscopic totally extraperitoneal repairs are well documented. However, because spigelian hernias are uncommon, few surgeons have a large volume of experience with spigelian hernia repairs. This is particularly true of the repair of spigelian hernias with concurrent inguinal and femoral hernias. We provide intraoperative images of bilateral spigelian and inguinal and femoral hernias repaired via a laparoscopic totally extraperitoneal approach. This patient was successfully treated with a single piece of mesh on each side. The single mesh piece on the right repaired the right spigelian hernia and a femoral hernia. The single mesh piece on the left repaired the spigelian hernia and left direct and indirect inguinal hernias. Preoperative computed tomography scans illustrate the close proximity of the spigelian defects and the inguinal defects that allow the use of a single 10 15-cm mesh piece for repair of each side. Our goal is to provide intraoperative images to allow a surgeon who is experienced with totally extraperitoneal repairs to visualize this operation and apply this approach to other patients with concurrent spigelian and inguinal or femoral hernias.

Key Words: Spigelian hernia, Laparoscopic, Minimally invasive surgery, Totally extraperitoneal repair, Inguinal hernia, Femoral hernia, Mesh repair.

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The post Intraoperative Images of the Totally Extraperitoneal Repair of Concurrent Spigelian and Groin Hernias first appeared on CRSLS.