Two-stage Laparoscopic Repair of Acutely Irreducible Groin Hernia

Abstract

In adults with acutely irreducible groin hernias, use of a mesh for hernia repair remains debatable in cases with an increased risk of infection. At our hospital, for such cases, we use 2-stage laparoscopic surgery. We present a case series of 7 patients who underwent this procedure. All the patients were women, with a mean age of 82 years. According to the new Japanese Hernia Society classification, the hernias were of the L type in 2 cases, of the M type in 1 case, and of the F type in 4 cases. The reasons for selecting 2-stage surgery were the presence of contaminated ascites in 3 cases, and need for concurrent intestinal resection in 4 cases. Hernia sac inversion and ligation were the procedures of first choice for preventing recurrence during the waiting period. Among the 7 cases, the 2-stage surgery could be performed electively without complications in 5 cases. The remaining 2 developed recurrent incarceration or abscess formation during the waiting period, likely attributable to peritoneal disruption at the initial surgery, and required additional treatment. Although appropriate case selection and surgical attention are needed at the initial operation, 2-stage laparoscopic hernia repair combined with hernia sac inversion and ligation is a rational treatment strategy for acutely irreducible groin hernias.