V-043 Laparoscopic TAPP repair for strangulated femoral hernia

Abstract

Abstract Aim To present a case of a strangulated femoral hernia successfully submitted to laparoscopic transabdominal preperitoneal (TAPP) repair and segmental enterectomy. Material and Methods Video recording of the surgical procedure and patient clinical files. Results A 75-year-old woman with previous medical history of diabetes and dyslipidaemia, went to the Emergency Department with complaints of generalized abdominal pain and absence of bowel moves since the previous day. On physical exam, an incarcerated left femoral hernia was evident. She also presented a renal dysfunction and computed tomography scan revealed a femoral hernia containing a bowel segment with upstream intestinal occlusion. Laparoscopic correction was proposed. Laparoscopy revealed an ischemic loop of bowel incarcerated in the femoral hernia defect, which was manually reduced. Signs of irreversible ischemia were present, but no perforation was evident. TAPP correction was performed with a polypropylene flat mesh of 37.8g/m2 with wide pores. After, the umbilical incision was extended and an extracorporeal segmental enterectomy with totally mechanical anastomosis was made. The patient had a favourable postoperative course with no complications. Conclusions Urgent groin hernia surgery with mesh requiring segmental enterectomy, but without gross peritoneal contamination, is associated with decreased recurrence rates and similar postoperative complications. In experienced centres, laparoscopic surgery may be associated with better results, although randomized multicentre studies are needed.