Inguinal and Incisional Hernia Emergency Management

Abdominal hernias are a common surgical pathology. Inguinal and incisional hernias are the most frequent types and up to 15% of these can have a complicated clinical presentation. Strangulated hernia requires an emergent management, because of risk of bowel necrosis and perforation. When surgical field is clean or clean-contaminated, the laparoscopic approach can be chosen, provided the surgeon has good experience in mini-invasive hernia repair and in emergency laparoscopy. For complicated inguinal hernia, the surgeon can use laparoscopy just to assess the bowel viability after his spontaneous reduction or to perform all surgical steps, with a reduction of bowel resection and wound infection rate. Both techniques, TAPP and TEP, are effective. If the only aim is abdominal exploration, a hybrid technique called hernioscopy consists in introducing a camera through inguinal ring. In case of incisional complicated hernia, the most difficult step in laparoscopy is adhesiolysis, because of risk of unintentional bowel lesions during loops manipulation. Hernia defect greater than 15 cm is better repaired by laparotomic approach. For both types of hernia, literature demonstrated similar results for mini-invasive technique compared to open approach, in terms of complications, mortality, and recurrence rate.