Abstract
The transabdominal pre-peritoneal (TAPP) approach has been the first choice for adult inguinal hernias in our department since 2009. The TAPP technique offers the following advantages: 1. Diagnostic accuracy; 2. The bilateral groin can be checked and immediately repaired; 3. Relief of postoperative pain and wound discomfort; and 4. Earlier rehabilitation. We have expanded our indication to incarcerated cases with the advancement of our technical stability and safety. In our strategy for incarcerated inguinal hernias, we first verify the viability and peristalsis of the incarcerated bowel with enhanced computed tomography and abdominal ultrasonography followed by reduction. Even if reduction is possible, we perform surgery within 24 hours to avoid false reduction or late perforation. If reduction is impossible, we laparoscopically determine the viability of the incarcerated bowel segment based on color, peristalsis, and venous congestion When bowel resection is not required, TAPP is performed in the usual manner. If bowel resection is required or the bacterial contamination is suspected, we postpone TAPP for the prophylaxis against prosthesis infection. We experienced 14 cases (15 hernias: 1 direct, 12 indirect, 2 femoral) between 2009 and 2013. In 11 cases TAPP was simultaneously performed after laparoscopic observation confirming the viability of the incarcerated bowel segment. TAPP was performed in 2 cases within 24 hours after undergoing reduction and postponed TAPP was performed in the remaining cases because the incarcerated bowel was perforated by strangulation. No conversion to open surgery occurred. It can be considered that TAPP could offer benefits with reliable and minimally invasive therapy, not only for elective cases, but also incarcerated cases.
