1 Introduction
Eincarcerated inguinal hernia. An optimal mergency surgery is necessary for an approach for incarcerated inguinal hernia surgery has yet to be established.
[1-
3] In our institution, an open (groin incision) approach is selected for safe and efficient surgery. However, a laparoscopic approach may also be recommended for some cases to confirm the viability of the strangulated organ and assess the condition of the whole abdominal cavity. Laparoscopy through the inguinal hernia sac is known as hernioscopy.
[4-
6] While hernioscopy has been proposed as a valid option to prevent an additional skin incision, it is not widely accepted and, thus, rarely applied. We herein report a case of an incarcerated inguinal hernia that underwent hernioscopy with the single-incision laparoscopic surgery (SILS) technique during emergency surgery.
2 Case Report
The patient was a 64-year-old man diagnosed with a right incarcerated inguinal hernia. The patient was admitted with right groin pain for 6 h. His body mass index was 22.8 kg/m2, and a fist-sized irreducible swelling was noted in the right groin in a physical examination. Computed tomography of the abdomen showed the features of a right inguinal hernia, dilated loops of the small bowel within the hernia sac, and collapsed loops distally with a transition point at the neck of the hernia [Figure 1].
We performed emergency surgery for the right incarcerated inguinal hernia with a groin incision. A lateral inguinal hernia was detected, and we completely mobilized the hernia sac as per the usual technique. During detachment, the strangulated small bowel fell back into the abdomen. It was not possible to pull out the bowel due to edema of the mesentery. To confirm the viability of the strangulated organ and assess the condition of the whole abdominal cavity, we attached LAP PROTECTOR and EZ ACCESS (both HAKKO MEDICAL) to the inguinal hernia sac with three 5-mm trocars [Figure 2]. We observed the whole abdominal cavity by hernioscopy with the SILS technique. Only mesenteric hematoma was noted, and the viability of the strangulated bowel was maintained [Figure 3]. Inguinal hernia repair using a mesh was performed without bowel resection. The patient was discharged without any postoperative complications.
3 Discussion
If the surgeons have sufficient experience of inguinal surgery, there are no significant differences in short outcomes (duration of operation time, or perioperative complications) between open and laparoscopic surgeries.
[1-
3] In other words, the surgical approach could be decided by preference of the surgeons. In our institution, a groin incision approach in emergency surgery for an incarcerated inguinal hernia is selected for the following reasons. If bowel resection is required, hernia repair without the use of a mesh (tissue repair method) may be necessary. A laparoscopic approach is associated with a number of risks, such as hemodynamic instability of the patient, adhesions due to a history of abdominal surgery, and difficulty in maintaining vision due to bowel obstruction prior to surgery.
Although hernioscopy has been reported, it is not widely accepted and, thus, is rarely applied.
[5,
6] The reason for this may be that single-port hernioscopy has few advantages because only the abdominal cavity is observed. The SILS technique reduces the number of ports required for cholecystectomy,
[7] and we have employed this technique for various surgical procedures. By using the SILS technique, surgeons are able to use forceps and perform various tasks within the abdominal cavity. Bowel resection may be performed by hernioscopy only if necessary.
There are some precautions that need to be considered. In emergency surgery for an incarcerated inguinal hernia, we perform the procedure via a groin incision. However, the initiation of surgery via laparoscopy is also appropriate.
[8,
9] Leib
et al. reported the safety of a laparoscopic approach for an incarcerated inguinal hernia surgery.
[10] Fundamentally, laparoscopic surgery has less chronic pain than open surgery,
[3] so laparoscopic surgery might have a better long-term prognosis. Hernioscopy may not be applicable to all patients, particularly patients with a femoral hernia. It is important to note that hernioscopy is not the only available method. We herein described hernioscopy with the SILS technique as one surgical option.
In conclusion, we presented a case of an incarcerated inguinal hernia that underwent hernioscopy with the SILS technique during emergency surgery and suggest its potential as a useful surgical option for incarcerated inguinal hernia surgery.
© 2026 International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press
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