Hernioscopic retrieval of bowel for evaluation of viability during repair of a Richter's-type incarcerated femoral hernia.

During the repair of a Richter's type incarcerated right femoral hernia via an infrainguinal approach, the incarcerated loop of bowel retracted back into the abdominal cavity before the bowel could be adequately examined for viability. To avoid a laparotomy to identify and possibly resect the involved loop of bowel, a laparoscope was introduced into the open femoral sac. Pneumoperitoneum was obtained, and the involved loop of small bowel was identified via the laparoscope, grasped with a grasping forceps from a second trocar port, and brought out through the hernia sac. The bowel was directly visualized and assessed for viability. This procedure required only a 5-mm trocar incision rather than an infraumbilical laparotomy incision, thus potentially minimizing postoperative morbidity, decreasing the length of hospital stay, and reducing postoperative pain. We propose this technique as a potentially useful alternative to a laparotomy in this situation on selected patients.