Endoscopic totally extraperitoneal repair of incarcerated inguinal hernia

Background. Incarcerated inguinal hernias have been considered a relative contraindication for endoscopic surgery, as its efficacy and safety is as yet unproven. With more experience and improved techniques, management of incarcerated hernias by the endoscopic approach has become possible with decreased patient discomfort and acceptable results. Aim and Objective. To analyze the feasibility and effectiveness of Endoscopic Totally Extraperitoneal repair in incarcerated inguinal hernias. Methods. We retrospectively analyzed 34 patients - admitted under a single surgical unit with chronically incarcerated inguinal hernias - who underwent an elective endoscopic totally extraperitoneal repair. The 6-year period studied was from May 1997 to May 2003. Demographic characteristics, operative details (including modifications in technique and use of drains) and postoperative outcome including analgesic requirements, hospital stay, complications, and time taken to resume normal activity, were evaluated. A comparison was made with the results of 286 endoscopic primary, non-incarcerated, unilateral endoscopic totally extraperitoneal hernia repairs done during the same period. Results. With the help of modified techniques for reduction of the hernial sac, all the patients underwent a successful TEP repair. There were no conversions. The mean operating time was 84.4 min compared to 57 min in the non-incarcerated group. Three-fourths of the patients could be discharged within 24 h. Analgesic requirement was for an average of 5.5 days (vs 4.2 days in the non-incarcerated group). Time taken to resume normal activity was 7.5 days (vs 5.6 days in the non-incarcerated group). Two recurrences occurred. Follow-up period ranged from 13 months to 84 months. Conclusions. With the help of modifications in operating technique, Endoscopic Totally Extraperitoneal repair is feasible and effective in patients with incarcerated inguinal hernias and encompasses the advantages of endoscopic procedures. © Springer-Verlag 2004.