Transhernial laparoscopy for assessment of bowel viability in incarcerated indirect inguinal hernia: A single-center retrospective study
Denizhan Kılıç1, Erhan Kızılkaya2, Nizamettin Kutluer31Department of General Surgery, Malatya Training and Research Hospital, Malatya, Türkiye2Department of General Surgery, Malatya Turgut Özal University Faculty of Medicine, Malatya, Türkiye
3Department of General Surgery, Elazığ Fethi Sekin City Hospital, Elazığ, Türkiye
INTRODUCTION: Assessment of bowel viability in incarcerated inguinal hernia remains challenging, often leading to exploratory laparotomy due to uncertainty. Hernia sac laparoscopy (transhernial laparoscopy) has been proposed as a minimally invasive adjunct to guide intraoperative decision-making. This study evaluates the safety and diagnostic performance of hernia sac laparoscopy in patients with incarcerated indirect inguinal hernia.
METHODS: A retrospective single-center analysis was conducted on 48 consecutive patients undergoing emergency surgery for incarcerated indirect inguinal hernia. In all cases, bowel viability was assessed via insertion of an 11-mm trocar through the hernia sac prior to definitive repair. Laparotomy was performed when ischemia was suspected. All patients underwent open Lichtenstein repair. Diagnostic performance parameters were calculated using bowel resection as confirmation of ischemia.
RESULTS: Midline laparotomy was required in 6 patients (12.5%). Five patients had confirmed bowel ischemia requiring resection with primary anastomosis. One patient underwent non-therapeutic laparotomy without resection. No bowel perforation or intra-abdominal contamination was observed. There were no cases of missed ischemia. Hernia sac laparoscopy demonstrated a sensitivity of 100%, specificity of 97.7%, positive predictive value of 83.3%, and negative predictive value of 100% for detecting bowel ischemia.
DISCUSSION AND CONCLUSION: Hernia sac laparoscopy is a safe and effective decision-guiding tool in incarcerated indirect inguinal hernia, demonstrating excellent sensitivity and negative predictive value for bowel ischemia. This technique may help avoid unnecessary laparotomy while maintaining surgical safety.
Keywords: Incarcerated inguinal hernia, hernia sac laparoscopy, bowel ischemia, bowel viability, emergency surgery
Denizhan Kılıç1, Erhan Kızılkaya2, Nizamettin Kutluer31
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Manuscript Language: English