Minimally Invasive Surgery for Inguinal Hernia

With an increasing incidence of prostate cancer in the UK, the number of radical prostatectomies carried out is also increasing. In 2014, 13% of men diagnosed with prostate cancer had a radical prostatectomy. Almost half of those were carried out with a robotic assisted approach; the remainder were performed by open surgery, conventional laparoscopy or transperineal prostatectomy. Inguinal hernia post radical prostatectomy is rarely discussed during the consent process but the incidence is estimated to be between 15% and 20%. There is a number of theories as to why this might occur including a weakness in the myopectineal orifice and as a result of opening the endopelvic fascia. In this article we aim to review the evidence for the development of inguinal herniae post radical prostatectomy and to assess whether the advent of minimally invasive surgery has altered this process.

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P038 MINIMALLY INVASIVE SURGERY & INCARCERATED INGUINAL HERNIA. CAN WE COMBINE THEM?

British Journal of Surgery ◽

10.1093/bjs/znab395.036 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Jorge Zárate Gómez ◽

Pedro Álvarez de Sierra Hernández ◽

David Fernández Luengas ◽

Silvia Conde Someso ◽

Guillermo Supelano Eslait ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Inguinal Hernia ◽

Minimally Invasive ◽

Invasive Surgery ◽

Intestinal Ischemia ◽

Intestinal Resection ◽

Minimal Invasive ◽

Incarcerated Inguinal Hernia ◽

Multiple Treatment ◽

Preperitoneal Approach

Abstract Aim After a long experience of more than 20 years in TEP hernioplasty we explore if it can also be suitable for emergency patients. Material and Methods We present different laparoendoscopic schemes that we have used in our Hospital to treat strangulated inguinal hernia according to clinical and radiological findings. Results TEP in now assumed to be one of the best options in scheduled surgery to treat inguinal hernia. Is now the time to change the paradigm by using it also in emergency surgery? Incarcerated inguinal hernia presents two problems: first of all the clinical emergency, an irreducible inguinal bulge that causes pain, obstruction and bowel ischemia; and second, the need to repair inguinal wall. While treating both problems, we have explored different minimally invasive surgery approaches according to each patient´s characteristics and the preoperative risk of intestinal resection based on CT findings. To reduce the incarcerated bulge, we use a laparoendoscopic methods. After a preperitoneal dissection, and with the help of external maneuvers, we try to reduce the content. If we are not successful, a quelotomy becomes necessary. To treat the inguinal defect we use TEP or TAPP approaches. Conclusions We seek to show that endoscopic preperitoneal approach in an incarcerated inguinal hernia is safe and possible, allowing us to maintain minimal invasive techniques. Laparoscopy allows us to explore and to treat possible complications of intestinal ischemia with no need of laparotomy. Multiple treatment schemes are possible for inguinal incarcerated hernia. The choice must be made according to the surgeońs experience, patient´s characteristic and the risk of intestinal ischemia.

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