V-026 UTILITY OF THE LAPAROSCOPIC APPROACH IN INCARCERATED GROIN HERNIAS: A VIDEO-CASE REPORT

Abstract

Abstract Aims Groin hernias are one of the most frequent pathologies in general surgery.Open repair remains the most widely used method.However,currently the minimally invasive approach is increasing, but the criteria or indications to use this approach in emergency surgery are still not entirely clear. Methods Video-case presentation. Results 62-year-old-man,who came to the emergency-room for abdominal pain, nausea and vomiting, associated with a small painful lump in the right groin.Physical examination:abdominal distension and a painful lump in the lower region of the right inguinal-ligament, non-reducible,CT-scan:small bowel obstruction due to incarcerated femoral-hernia.We decide to perform an urgent surgical-intervention using a minimally-invasive-approach(Lap-TAPP). A laparoscopic-TAPP-approach is performed with 3ports(1×12 and 2×5mm).An incarcerated small bowel is observed in the right-femoral-region with signs of distress and causes retrograde dilation of the small bowel loops,with meticulous pulling maneuvers reduction of the incarcerated small bowel is achieved.Peritoneal opening is performed and the Retzius and Bogros-space is dissected, subsequently the cord is dissected and the round ligament is sectioned,a 10×14cm PPL-mesh is placed.The peritoneum is closed with a 3/0V-Lock.Finally,we reviewed the small bowel and performed an invaginating suture on the incarcerated antimesenteric border.The patient presented a satisfactory evolution and was discharged the 1°POD. Conclusion Incarcerated inguino-crural hernia has a high risk of morbidity and mortality.The surgeon on call must have different technical resources to deal with this pathology.The Lap-TAPP approach allow us to check the viability of the incarcerated small bowel.In selected cases,experienced surgeons can perform laparoscopic small bowel resection and anastomosis in patients with necrosis or perforation.