A Novel Treatment Strategy for Acutely Incarcerated Femoral Hernia based on Endoscopic Surgery

Abstract

During emergency surgery for an acutely incarcerated femoral hernia, intestinal resection may often be needed. Tension-free hernia repair with the use of a mesh is generally avoided in the case of intestinal resection, due to the risk of mesh infection, so a Mcvay repair or pure tissue repair is usually performed. However, it is obvious that tension-free hernia repair with a mesh is a more desirable operation than pure tissue repair, since most elective hernia surgeries not involving strangulation are performed using mesh. We report herein on a novel treatment strategy, which may enable the surgeon to repair the hernia with mesh in all cases, even if strangulation is recognized, and that endoscopic surgery is very useful for minimally invasive surgery. First, the condition of the intestine is verified laparoscopically. If indicated, intestinal resection is performed via an extended 3-cm umbilical incision. Hernia repair is then performed with an anterior approach without injuring the peritoneum, which stands between the mesh and the abdominal cavity. Consequently, the risk of mesh infection is minimized, as is the risk of complications associated with elective hernia surgery.