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Smith et al. Mini-invasive Surg 2021;5:34 https://dx.doi.org/10.20517/2574-1225.2021.44 Page 3 of 5

Table 1. Hospital course of patients presenting with strangulated groin hernias repaired by trans-abdominal preperitoneal mesh
repair with concomitant small bowel resection
Reduced in LOS, Discharge 30-day
Pt Hernia type Diagnosis Hospital course F/u Antibiotics
ED days location outcomes
A Not Strangulated right CT Ileus, TPN 7 Home No recurrence, Yes Preop
attempted femoral infection or
readmission
B Attempted, Strangulated left Clinical Ileus, TPN, urinary retention, 12 Home No recurrence, Yes 5 days
not reduced direct inguinal pelvic abscess treated with infection or postop
aspiration & trimethoprim- readmission
sulfamethoxazole
C Attempted, Strangulated left CT Uneventful recovery 5 SNF No recurrence, Yes Preop
not reduced femoral infection or
readmission
D Attempted, Strangulated left CT Fall from bed, right face 4 Home with No recurrence, Yes Preop
not reduced femoral hematoma home health infection or
readmission
E Not Strangulated left CT Clostridium difficile diarrhea, 17 SNF Readmitted within No 24 h postop
attempted femoral treated with metronidazole 30 days for MRSA
cellulitis on upper
extremity
F Not Strangulated right CT Oral thrush, Ileus, pulmonary 7 SNF No recurrence, No 24 h postop
attempted femoral edema, HAP, urinary infection or
retention readmission
G Not Strangulated right Clinical, CT Ileus 6 Home No recurrence, Yes Preop
attempted direct inguinal infection or
readmission
H Not Strangulated CT Uneventful recovery 2 Home No recurrence, Yes Preop
attempted recurrent left infection or
femoral readmission
I Not Strangulated right CT Uneventful recovery 4 Home No recurrence, Yes Preop
attempted femoral, non- infection or
incarcerated left readmission
femoral

Pt: Patient; ED: emergency department; LOS: length of stay; F/u: follow up; CT: computed tomography; TPN: total parenteral nutrition; HAP:
hospital acquired pneumonia; SNF: skilled nursing facility; MRSA: methicillin resistant Staphylococcus aureus.

[9]
3-month strangulation risk of 22% and 21-month risk of 45% . Laparoscopic and open approaches exist for
repair of strangulated hernias. Although laparoscopic repair necessitates placement of mesh, doing so in a
clean or clean-contaminated setting is considered acceptable. Furthermore, laparoscopy provides the ability
to better assess bowel viability as compared to an open anterior repair , and it permits mesh coverage of
[10]
both the inguinal and femoral spaces. This study adds to the literature on the safety of the laparoscopic
approach.

There is no clear consensus on the best surgical approach for repairing strangulated groin hernias, but many
reports have demonstrated laparoscopic repair as a safe option. Matsuda et al. performed a retrospective
[4]
review of patients with acute strangulated hernia who either underwent open anterior repair or laparoscopic
TAPP repair. There were no recurrences in either group, and complication rates were similar. While TAPP
took longer to perform, the associated hospital stay was shorter . Chihara et al. prospectively followed
[5]
[4]
patients with incarcerated or strangulated groin or obturator hernias who underwent either laparoscopic or
open repair. In the laparoscopic group, one patient had conversion to a laparotomy, and 7 patients had a
second-stage TAPP repair performed after bowel repair or resection. There were no instances of mesh
infection in the laparoscopic group, but one patient did suffer mesh infection in the open group. While the
laparoscopic method again took significantly longer, it also displayed a decreased postoperative
complication rate and hospital length of stay .
[5]