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Page 2 of 5 Smith et al. Mini-invasive Surg 2021;5:34 https://dx.doi.org/10.20517/2574-1225.2021.44

[1,2]
needed for recovery . Strangulated groin hernias present a more unique problem in which the contents of
the hernia may be compromised and nonviable. Because of this, repair of these hernias was traditionally
done via an open approach, partly due to the difficulty in safely reducing herniated contents
laparoscopically. The other reason relates to the risk of leaving prosthetic material in a potentially infected
field, therefore increasing surgical site infection risk and warranting open tissue repair . Despite this
[3]
dogma, laparoscopic repair with mesh has been documented as a safe approach for strangulated groin
hernias . However, there are no robust data to support this. We present our experience with the use of
[4-8]
laparoscopic repair of strangulated groin hernias with concomitant bowel resection to support that this is a
safe and effective option.

CASE REPORT
Methods
This is a retrospective review of a single surgeon’s operative experience from January 2013 to July 2019 of all
patients presenting with strangulated inguinal or femoral hernia who underwent laparoscopic
transabdominal preperitoneal repair with small bowel resection. Demographic, perioperative, and short-
term outcomes were reviewed, and descriptive statistics were performed (Microsoft Excel, 2019).

Results
Nine patients underwent laparoscopic mesh repair and small bowel resection for strangulated inguinal or
femoral hernia over 6 years. All patients initially presented to the emergency department (ED). Hernias
were repaired laparoscopically with a trans-abdominal preperitoneal (TAPP) approach with Bard 3DMax
TM
light mesh and secured with Covidien 5 mm Protack , which is our preferred approach. Four tacks were
TM
used to secure the mesh in 8 cases, and one required 6 tacks. All patients had an open small bowel resection
through a small periumbilical incision at the laparoscopic port site.

Diagnosis was made clinically in one patient and the remainder underwent computed tomography in the
emergency department prior to evaluation by a surgeon. One patient with end-stage dementia was initially
elected for hospice care and after 48 h, the family decided to pursue surgery. Three patients had attempted
hernia reduction in the ED, and one was successfully reduced, but reincarcerated and was repaired 6 h after
presentation. The remainder were taken to the operating room within 4 h of presentation. Two hernias were
direct inguinal and seven were femoral. One of the femoral hernias was recurrent, and one patient had
bilateral femoral hernias, only one of which was incarcerated; both were repaired [Table 1]. In two cases, the
surgeon was consulted intraoperatively by other surgeons that were on call.

The median age was 83 years (IQR 68, 85). One was male and all were Caucasian. Interestingly, none were
diabetic. The median BMI was 20.97 kg/m (IQR 19.93, 22.08). Five patients were ASA 3-4. Postoperative
2
median hospital length of stay was 6 days (IQR 4, 7). Three patients were discharged to a skilled nursing
facility, while the rest were discharged home. One patient developed a small deep pelvic abscess treated with
CT-guided aspiration and antibiotics. Two patients were lost to follow up. There were no known hernia
recurrences or mesh infections at 30 days, nor were any identified during the time of chart review. Four
patients were deceased at time of chart review, and the one who died within 90 days postoperatively was the
same patient that initially chose hospice [Tables 1 and 2].

DISCUSSION
Hernias of the groin are common, but strangulated groin hernias are relatively rare. The risk of
strangulation is higher in the case of femoral hernias. The risk of strangulation in inguinal hernias is
documented as 2.8% at 3 months, increasing to 4.5% at 2 years. Femoral hernias, on the other hand, carry a