Laparoscopic repair of a Littre’s hernia with porcine dermal collagen implant (Permacol)

Abstract

Littre's hernia was originally defined as "the presence of a Meckel's diverticulum in any hernia sac" by Rieke in 1841. It is a rare finding at any age, and its true incidence is unknown. The conventional treatment for Littre's hernia is wedge resection of the diverticulum and repair of the hernia from within the sac. However, the advent of laparoscopic surgery has altered the management of all abdominal hernias, including Littre's hernia. We present a case of a 55-year-old woman who presented as an emergency with right iliac fossa pain and tenderness. A CT scan demonstrated a 46 x 25 x 25 mm lesion related to the distal ileum extending towards the inguinal canal. At laparoscopy she was found to have a Meckel's diverticulum herniating through the deep inguinal ring into the right inguinal canal. We report the laparoscopic excision of the Meckel's diverticulum using an endoscopic stapling device and repair of this hernia with Permacol, an acellular porcine collagen mesh. The patient made a quick recovery and was discharged 5 days post-operatively. A complication of an umbilical port site infection was treated 2 weeks post-operatively with oral antibiotics. To date there has been no recurrence of the hernia and no right inguinal pain. Laparoscopic repair of Littre's hernia using Permacol has not been reported previously. Laparoscopy is a safe, inexpensive and efficient method for the diagnosis and treatment of Littre's hernia. Permacol is a strong yet supple material for hernia repair.