G D Tebala1,2, A Kola-Adejumo3, J Yee3. 1. Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK. giovanni.tebala@nhs.net. 2. East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent, TN24 0LZ, UK. giovanni.tebala@nhs.net. 3. East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent, TN24 0LZ, UK.
Abstract
PURPOSE: The diagnosis of bowel or omental ischaemia in strangulated inguinal hernias needs visual exploration of the content of the hernia sac. In some cases, the content of the sac retracts spontaneously into the abdomen at the induction of anaesthesia, so making sure of its viability can be quite difficult. Hernioscopy can allow direct inspection of the whole abdominal cavity and the performance of surgical procedures such as small bowel, large bowel or omental resection, without the need of a formal laparotomy. METHODS: Hernioscopy entails inserting a 10-12-mm trocars in the hernia sac, after its complete mobilization. A 30° camera is then passed into the abdomen through the sac and a thorough examination of the abdominal cavity is performed. If necessary, accessory trocars can be inserted into the hernia sac or through the abdominal wall to perform additional procedures such as bowel resection. After the exploration and the eventual resection, the operation is concluded with a tension-free mesh repair of the hernia. RESULTS: We performed hernioscopy on eight patients. In four of them, no ischaemia was found and the operation was concluded with mesh repair of the hernia. In four patients, a further operative procedure was necessary. No significant postoperative surgical complications were recorded. CONCLUSIONS: Hernioscopy is an easy and reliable method to explore the abdominal cavity and make sure of the viability of the bowel in patients with strangulated inguinal hernia and to proceed to minimally invasive resection if needed.
PURPOSE: The diagnosis of bowel or omental ischaemia in strangulated inguinal hernias needs visual exploration of the content of the hernia sac. In some cases, the content of the sac retracts spontaneously into the abdomen at the induction of anaesthesia, so making sure of its viability can be quite difficult. Hernioscopy can allow direct inspection of the whole abdominal cavity and the performance of surgical procedures such as small bowel, large bowel or omental resection, without the need of a formal laparotomy. METHODS: Hernioscopy entails inserting a 10-12-mm trocars in the hernia sac, after its complete mobilization. A 30° camera is then passed into the abdomen through the sac and a thorough examination of the abdominal cavity is performed. If necessary, accessory trocars can be inserted into the hernia sac or through the abdominal wall to perform additional procedures such as bowel resection. After the exploration and the eventual resection, the operation is concluded with a tension-free mesh repair of the hernia. RESULTS: We performed hernioscopy on eight patients. In four of them, no ischaemia was found and the operation was concluded with mesh repair of the hernia. In four patients, a further operative procedure was necessary. No significant postoperative surgical complications were recorded. CONCLUSIONS: Hernioscopy is an easy and reliable method to explore the abdominal cavity and make sure of the viability of the bowel in patients with strangulated inguinal hernia and to proceed to minimally invasive resection if needed.
Authors: Gaetano Piccolo; Andrea Cavallaro; Emanuele Lo Menzo; Antonio Zanghì; Maria Di Vita; Paolo Di Mattia; Alessandro Cappellani Journal: Surg Laparosc Endosc Percutan Tech Date: 2014-02 Impact factor: 1.719