Vol. 151 No. 0708 (2021)
Enhanced-view totally extraperitoneal approach in emergency ventral incision hernia repair: a case report
- Sameer Nazeeruddin
- Fabio Butti
- Gilles Herren
The rate of emergency operations for incarcerated and strangulated ventral hernias is about 10–15%, with worse outcomes than elective surgery. A recent laparoscopic technique called the enhanced-view totally extraperitoneal approach (eTEP) was shown to be indicated in elective repair of ventral and incisional hernias, and has a lower rate of postoperative morbidity than the Rives-Stoppa technique, while having the same indications. However, use of the eTEP laparoscopic technique in emergency ventral hernia repair has not yet been reported.
We report the case of a 57-year-old white male, with history of multiple abdominal interventions by laparotomy, admitted to the emergency department with progressive vomiting and periumbilical pain for 3 days. On clinical examination, we found a strangulated incisional para-umbilical hernia with local cellulitis and tenderness in the right flank. Abdominal computed tomography confirmed the diagnosis and showed some signs of thickening of the intestinal wall and multiple ventral hernias.
The patient was admitted and operated on the same day with use of the eTEP technique and without the need for intestinal resection. The patient was discharged on postoperative day 5. The main complication was the presence of a seroma diagnosed and drained by means of an extraperitoneal laparoscopy after 3 weeks. Total resolution of the seroma was confirmed at 1-year follow up. Incarcerated and strangulated ventral hernias are still classically treated by laparotomy. This case report shows for the first time that the eTEP procedure can be applied for abdominal wall surgery also in the emergency setting in selected patients. We hypothesise that this new procedure can be a promising approach leading fewer postoperative complications and shorter hospital stays.
- Reza Zahiri H, Belyansky I, Park A. Abdominal Wall Hernia. Curr Probl Surg. 2018;55(8):286–317. doi:.https://doi.org/10.1067/j.cpsurg.2018.08.005
- Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A, et al. Incisional hernia rate 3 years after midline laparotomy. Br J Surg. 2014;101(2):51–4. doi:.https://doi.org/10.1002/bjs.9364
- Yang GPC. Laparoscopy in emergency hernia repair. Ann Laparosc Endosc Surg. 2017;2(6). Available at: http://ales.amegroups.com/article/view/4017. Accessed 2020 April 23.
- Birindelli A, Sartelli M, Di Saverio S, Coccolini F, Ansaloni L, van Ramshorst GH, et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg. 2017;12:37. doi:. https://doi.org/10.1186/s13017-017-0149-y
- Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T. Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study. World J Surg. 2013;37(10):2273–9. doi:.https://doi.org/10.1007/s00268-013-2123-5
- Beadles CA, Meagher AD, Charles AG. Trends in emergent hernia repair in the United States. JAMA Surg. 2015;150(3):194–200. doi:.https://doi.org/10.1001/jamasurg.2014.1242
- Turner PL, Park AE. Laparoscopic repair of ventral incisional hernias: pros and cons. Surg Clin North Am. 2008;88(1):85–100, viii. doi:.https://doi.org/10.1016/j.suc.2007.11.003
- Deeba S, Purkayastha S, Paraskevas P, Athanasiou T, Darzi A, Zacharakis E. Laparoscopic approach to incarcerated and strangulated inguinal hernias. JSLS. 2009;13(3):327–31.
- Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS, et al. A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc. 2018;32(3):1525–32. doi:.https://doi.org/10.1007/s00464-017-5840-2
- Belyansky I, Zahiri HR, Park A. Laparoscopic Transversus Abdominis Release, a Novel Minimally Invasive Approach to Complex Abdominal Wall Reconstruction. Surg Innov. 2016;23(2):134–41. doi:.https://doi.org/10.1177/1553350615618290
- Pechman DM, Cao L, Fong C, Thodiyil P, Surick B. Laparoscopic versus open emergent ventral hernia repair: utilization and outcomes analysis using the ACSNSQIP database. Surg Endosc. 2018;32(12):4999–5005. doi:.https://doi.org/10.1007/s00464-018-6312-z
- Azin A, Hirpara D, Jackson T, Okrainec A, Elnahas A, Chadi SA, et al. Emergency laparoscopic and open repair of incarcerated ventral hernias: a multi-institutional comparative analysis with coarsened exact matching. Surg Endosc. 2019;33(9):2812–20. doi:.https://doi.org/10.1007/s00464-018-6573-6
- Reinke CE, Matthews BD. What’s New in the Management of Incarcerated Hernia. J Gastrointest Surg. 2020;24(1):221–30. doi:.https://doi.org/10.1007/s11605-019-04352-4
- Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg. 1989;13(5):545–54. doi:.https://doi.org/10.1007/BF01658869