Reduction En Masse of an Inguinal Hernia Repaired Laparoscopically Using Blood Flow Evaluation with Indocyanine Green—A Case Report—

Abstract

An 81-year-old woman had a prolapsed left inguinal hernia for several years which she had repeatedly self-reduced. During hospitalization for another medical condition, a left inguinal bulge was observed. Despite manual manipulation based on the diagnosis of a fitted left inguinal hernia, the patient continued to exhibit symptoms of intestinal obstruction. An inguinal ultrasound scan revealed a hernia in situ, diagnosed as a false return of hernia, and the patient was advised to undergo surgery. Intraoperative findings showed that the small intestine had fallen into the preperitoneal space with a Richter-shaped hernia sac. After confirming blood flow with the indocyanine green method and verifying the absence of intestinal resection, a laparoscopic hernia repair using the transabdominal preperitoneal technique with mesh was performed. Reduction en masse is a rare condition wherein the prolapsed organ remains fitted within the hernia sac and is completely retracted into the preperitoneal space. Although securing the surgical field using an anterior approach is difficult, laparoscopic surgery is useful because it provides a good surgical field.