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Page 4 of 5 Smith et al. Mini-invasive Surg 2021;5:34 https://dx.doi.org/10.20517/2574-1225.2021.44

Table 2. Patient demographics and comorbidities of patients presenting with strangulated groin hernias repaired by trans-abdominal
preperitoneal mesh repair with concomitant small bowel resection
Age, Cardiac Pulmonary Other
Pt Sex ASA Smoker BMI Deceased Cause of death
years history history history
A 57 F 2 Current 20.80 HTN COPD No
B 68 F 2 Never 20.97 No
C 83 F 3 Former 22.08 HTN CVA Yes Died in hospice from upper
gastrointestinal hemorrhage 5 years
later
D 93 F 3 Never 22.03 HTN, CAD, Yes Died 2 years postoperatively, cause
pacemaker, not listed
CABG
E 92 M 4 Unknown 18.64 HTN, CAD, COPD, Dementia Yes Readmitted 6 weeks postoperatively
pacemaker, IHD pulmonary and died from CHF exacerbation and
HTN MRSA cellulitis
F 85 F 4 Current 19.93 HTN, atrial COPD Yes Died 3 years later from complications
fibrillation from CVA
G 62 F 1 Never 22.50 no
H 75 F 2 Former 26.25 HTN No
I 85 F 3 Never 17.47 No
Pt: Patient; ASA: American Society of Anesthesiologists physical status classification; BMI: body mass index; F: female; M: male; HTN:
hypertension; CAD: coronary artery disease; CABG: coronary artery bypass graft; IHD: ischemic heart disease; COPD: chronic obstructive
pulmonary disease; CVA: cerebrovascular accident; CHF: congestive heart failure; MRSA: methicillin resistant Staphylococcus aureus.

This case series supports the use of laparoscopic TAPP repair for strangulated groin hernias. In our
experience, TAPP is a safe approach with concomitant bowel resection, as long as frank perforation with
gross spillage of succus does not occur. Similar recurrence rates are generally seen between the open and
laparoscopic approaches, and some argue decreased complications with the laparoscopic method. TAPP
gives the ability to reduce the hernia under direct visualization while permitting assessment of bowel
viability in real time. Further, in the laparoscopic approach, the mesh covers the direct, indirect and femoral
spaces, theoretically preventing future herniation through the other spaces, which is not always the case in
open approaches.

Ultimately, the surgeon should choose the repair with which he or she is most comfortable and familiar. As
surgeons become more facile with laparoscopic repair, it should be considered for incarcerated hernias due
to the benefits of more complete bowel assessment for viability, reduced pain, time to recovery, and hospital
stay.

Conclusion
Strangulated groin hernia is a rare medical emergency that warrants rapid operative repair. The best method
of repair in this setting is not well defined, but laparoscopic repair with mesh appears to be a safe and
effective option, even when bowel resection is performed. The authors support the use of laparoscopic
repair if it fits the experience and comfort of the surgeon.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Smith A, Hope W, Fox S
Performed data acquisition, as well as provided administrative, technical, and material support: Bilezikian J,
Hope W