Hybrid method using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia in a patient with liver cirrhosis and severe varicose veins: A case report

Abstract

Introduction Cirrhosis is a significant determinant of postoperative morbidity and mortality. Patients with severe liver cirrhosis are substantially contraindicated for surgical treatment of inguinal hernia because of the substantial recurrence rate and high postoperative morbidity and mortality. However, hernia with incarceration and strangulation, which could become life-threatening, should be repaired urgently even for patients with severe liver cirrhosis. No clear surgical guidelines have been established regarding the treatment strategy for inguinal hernia in patients with cirrhosis. Presentation of case A 62-year-old man with a history of chronic C-type liver cirrhosis (Child-Pugh classification C) and hepatocellular carcinoma was referred to us for surgical treatment of an irreducible right inguinal hernia. An abdominal computed tomography (CT) scan revealed that the small intestine had herniated into the scrotum and severe abdominal wall varicose veins due to liver cirrhosis. We performed a hybrid method that combines examination laparoscopy and Lichtenstein's technique to observe the abdominal cavity and to avoid the risks due to severe varicosis of the inferior epigastric vein. Discussion There have been some reports of inguinal hernia with cirrhosis and ascites, but no reports of incarcerated inguinal hernia with abdominal wall varicose veins. In the present case, we chose a laparoscopic approach to observe the abdominal cavity to confirm intestinal necrosis. Hybrid surgery using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia could be performed safely. Conclusion Hybrid surgery using laparoscopy and Lichtenstein's technique may be an effective method for patients with incarcerated inguinal hernia with end-stage cirrhosis and severe abdominal varicosis.

Case Report: Robotic-Assisted Minimally Invasive Repair of a Direct Sliding Left Inguinal Hernia Containing Bladder and Colon

“…Yane et al described a case in which the incarcerated small intestine was reduced laparoscopically but mesh repair was performed via an anterior open approach because they found the right inferior epigastric vein was severely varicotic and it was hazardous to detach the anterior peritoneal cavity intraabdominally. Via this approach, they reported no intra- or postoperative complications [ 13 ]. Complications may arise due to variability in course and anastomosis of inferior epigastric vessels.…”

A case of direct inguinal hernia incarceration after transperitoneal robot‐assisted radical prostatectomy

“…In contrast, the advantages of the laparoscopic approach, which have recently been increasing, 6,7 include an accurate diagnosis of the inguinal hernia and contralateral inguinal hernia and a faster recovery with less chronic pain 8 . In addition, infection in the abdominal cavity and necrosis of the incarcerated intestine after reduction can be detected using laparoscopy 9 . However, the disadvantages of the laparoscopic approach include the requirement for preperitoneal dissection after RARP with technical difficulty due to the postoperative adhesion 3,6 and possibility of the mesh not being fully covered by the peritoneum due to the deficient peritoneum.…”

“…8 In addition, infection in the abdominal cavity and necrosis of the incarcerated intestine after reduction can be detected using laparoscopy. 9 However, the disadvantages of the laparoscopic approach include the requirement for preperitoneal dissection after RARP with technical difficulty due to the postoperative adhesion 3,6 and possibility of the mesh not being fully covered by the peritoneum due to the deficient peritoneum. In the present case, it appears that the laparoscopic approach had advantages in dissecting intracorporeal adhesions from inside the abdominal cavity with preservation of the transverse fascia and in diagnosing the contralateral hernia.…”