A novel laparoscopic non-resective technique for the management of strangulated Richter's hernia.

Abstract

The incidence of Richter's hernias has risen in part due to the increment use of laparoscopic surgery. The standard technique to manage a strangulated Richter's hernia is bowel resection with anastomosis. Alternatively, invagination of the necrotic area in the enterocele maintains a clean surgical field and allows for the use of a mesh when closing the abdominal wall. In a sterile surgical field, the use of a prosthetic reinforcement has shown advantages, including low rates of long-term complications and reduced rates of hernia recurrence. A 35-year-old male presented with a strangulated Richter's hernia in a periumbilical abdominal wall defect. In the Operating Theatre, the necrotic segment was managed laparoscopically by plication with invagination allowing for abdominal wall reconstruction with a mesh. We propose the laparoscopic repair of Richter's hernia with plication and invagination whenever feasible, therefore avoiding a bowel resection and maintaining a clean surgical field; which allows for use of prosthetic mesh. • Richter hernias are becoming more common, mostly as a result of port-site closure defects after laparoscopic surgery • Avoiding bowel resection will increase the likelihood of a successful long-term mesh implant and decrease hernia recurrences. • Likewise, avoiding a bowel anastomosis will prevent additional contamination while simplifying the procedure.