From 2001 to May 2010, 659 patients with
inguinal hernia underwent
TAPP repair at in our institutes. Among these, the eight patients with
OH were the subjects of this study.
RESULTS: Three of the eight patients were diagnosed as having occult
OH, and the other five were diagnosed preoperatively, by ultrasonography and/or computed tomography, as having strangulated
OH. Bilateral
OH was found in five patients (63%), and combined groin
hernias, either unilaterally or bilaterally, were observed in seven patients (88%), all of whom had
femoral hernia. Of the five patients with bowel obstruction at presentation, four were determined not to require resection after assessment of the intestinal viability by laparoscopy. There was one case of conversion to a two-stage
hernia repair performed to avoid mesh contamination: addition of mini-
laparotomy, followed by extraction of the gangrenous intestine for resection and anastomosis with simple peritoneal closure of the
hernia defect in the first stage, and a Kugel
hernia repair in the second stage. There was no incidence of postoperative morbidity, mortality, or recurrence.
CONCLUSIONS: Because
TAPP allows assessment of not only the entire groin area bilaterally but also simultaneous assessment of the viability of the incarcerated intestine with a minimum abdominal wall defect, we believe that it is an adequate approach to the treatment of both occult and acutely incarcerated
OH. Two-stage
hernia repair is technically feasible in patients requiring resection of the incarcerated intestine.