De Garengeot Hernia Complicated by Acute Appendicitis in a Patient Who Simultaneously Underwent Elective Laparoscopic Appendectomy and Femoral Hernia Repair by Transabdominal Preperitoneal Repair

De Garengeot’s hernia is a rare entity in which the appendix is located within a femoral hernia and is almost invariably encountered incarcerated in an emergency setting. The clinical presentation is usually that of an incarcerated femoral hernia and is indistinguishable from other incarcerated femoral hernias. Here, we report on a 48-year-old female patient, known for a post-operative chronic seroma in the right groin since childhood, with a rare clinical presentation of a De Garengeot hernia. An abdominal CT-scan was performed, revealing an appendicitis with a stercolith in a femoral hernia. Generally, an inguinal approach alone (McVay procedure) is chosen and provides access for both appendectomy and hernia repair. In the absence of concomitant acute appendicitis, trans-abdominal pro-peritoneal laparoscopy (TAPP) could also be used as a single approach. In case of a rare presentation of acute appendicitis with probable contamination of the groin, we propose the double approach of laparoscopic appendectomy and hernia repair either with (if hernia sac is not opened during surgery) or without mesh. This approach is not yet described in the literature, and we think it the best technique to perform the appendectomy and hernia repair with little contamination of the groin.

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Outcome of laparoscopic transabdominal preperitoneal repair for complicated inguinal hernia in adults at the Hue Central Hospital - II

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2020.5.3 ◽

2020 ◽

Vol 10 (5) ◽

Author(s):

Thanh Xuân Nguyễn ◽

Đức Anh Lê

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Preperitoneal Repair ◽

Central Hospital ◽

Strangulated Hernia ◽

Totally Extraperitoneal ◽

Transabdominal Preperitoneal ◽

Transabdominal Preperitoneal Repair ◽

The Mean

Abstract Introduction: Laparoscopic approaches for inguinal hernia, including transabdominal preperitoneal repair (TAPP) and the totally extraperitoneal approach (TEP), are effective and widely accepted in elective inguinal hernioplasty. The choice an procedure for complicated inguinal hernia repair still controversial. Since the TAPP approach has advantages in assessing hernia content and decreasing incision infection rate and early recovery after surgery. Materials and Methods: Study participants included 17 patients of complicated inguinal hernia treated by TAPP technique at the Hue Central Hospital - Base 2 from 6/2019 though 6/2020. Descriptive and prospective follow-up study. Results: The mean age was 67,4 ± 14,85. Strangulated hernia and incarcerated hernia respectively accounted for 41,2% and 58.8% among cases. 94,1% cases were indirect hernia. 12 cases (70,6%) were right sided and 5 cases (29,4%) were left sided hernias. The content was small bowel in 58,8% cases, omentum in 23,5% cases and both in 11,8% cases, colon in 5,9%. 7 patients of strangulated hernia with recovery bowel and non resection. The mean durations of unilateral inguinal hernia repair were 77,2 ± 19.3 mins. Mean duration of postoperative stay was 4.2 ± 2.1 days. Postoperativer complications were 5,9% seroma formation. At 6-months evaluation, 1 case was reported with sensation disorder of inguinal area and there was no recurrence. Conclusions: TAPP is a safe and effective surgical technique for incarcerated inguinal hernia repair. Keywords: Strangulated inguinal hernia, incarcerated, TAPP, laparoscopic, mesh. Tóm tắt Đặt vấn đề: Phẫu thuật nội soi điều trị thoát vị bẹn ngày càng phổ biến rộng rãi với hai phương pháp TEP (totally extraperitoneal) và TAPP (transabdominal preperitoneal). Những trường hợp thoát vị bẹn có biến chứng việc lựa chọn phương pháp điều trị vẫn còn nhiều quan điểm khác nhau. Với cách tiếp cận bên trong khoang phúc mạc phương pháp TAPP có lợi thế trong việc đánh giá tạng thoát vị, giảm tỉ lệ nhiễm trùng và hồi phục nhanh sau phẫu thuật. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả, theo dõi dọc 17 người bệnh thoát vị bẹn có biến chứng được phẫu thuật TAPP tại Bệnh viện Trung ương Huế - Cơ sở 2 từ 06/2019 đến 06/2020. Kết quả: Tuổi trung bình 67,4 ± 14,85 tuổi. Thoát vị bẹn nghẹt 7 người bệnh (41,2%); thoát vị bẹn cầm tù 58,8%. 94,1% thoát vị thể gián tiếp. Bên phải có 12 người bệnh chiếm 70,6%, bên trái 29,4%. Tạng thoát vị được giải phóng 58,8% ruột non; 29,4% mạc nối; 11,8% ruột non và mạc nối và 5,9% là đại tràng. 7 người bệnh thoát vị nghẹt có sự hồi phục ruột non không phải cắt bỏ. Thời gian phẫu thuật trung bình 77,2 ± 19,3 phút. Thời gian nằm viện sau mổ trung bình 4,2 ± 2,1 ngày. Biến chứng sớm sau phẫu thuật 5,9% tụ dịch bẹn bìu. Sau 6 tháng có 1 trường hợp rối loạn cảm giác vùng bẹn; không có trường hợp nào tái phát

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Feasibility of a new approach for creating a preperitoneal space in transabdominal preperitoneal repair inguinal hernia repair: using a sandwich approach

Surgery Today ◽

10.1007/s00595-016-1435-0 ◽

2016 ◽

Vol 47 (5) ◽

pp. 595-600 ◽

Cited By ~ 3

Author(s):

Yoshio Nagahisa ◽

Shusaku Homma ◽

Kai Chen ◽

Reo Sakurai ◽

Nobuaki Hattori ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Preperitoneal Space ◽

Preperitoneal Repair ◽

New Approach ◽

Transabdominal Preperitoneal ◽

Transabdominal Preperitoneal Repair

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De Garengeot’s hernia with appendicitis—a rare cause of an acutely painful groin swelling

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz142 ◽

2019 ◽

Vol 2019 (5) ◽

Cited By ~ 2

Author(s):

Adam O’Connor ◽

Peter Asaad

Keyword(s):

Acute Appendicitis ◽

Hernia Repair ◽

Mesh Repair ◽

Vermiform Appendix ◽

Short Review ◽

Review Of The Literature ◽

Hernia Sac ◽

De Garengeot’S Hernia ◽

De Garengeot Hernia ◽

Groin Swelling

Abstract De Garengeot hernia is a rare subtype of femoral hernia whereby the vermiform appendix is located within the hernial sac. Even rarer is the presence of appendicitis within the hernia sac. De Garengeot’s hernia is difficult to diagnose pre-operatively and can prove technically difficult at operation particularly with regards to mobilization of the caecum and appendix in order to perform appendicectomy. Laparoscopic, open, with and without mesh repair of de Garengeot hernia have all been described in the literature with varying degrees of success. We present a case of an 82 year old lady presenting with an acutely painful right sided groin lump. CT scan revealed the presence of de Garengeot hernia with acute appendicitis. We describe in text and photo format our approach to the hernia repair, appendicectomy and provide a short review of the literature with regards to the different operative approaches to such a patient.

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