INCARCERATED HERNIA - PREPERITONEAL REPAIR
The advantages with the preperitoneal approach are obvious when dealing with an incarcerated and strangulated hernia, be it inguinal or femoral. In this example the hernia was femoral and the incarcerated small bowel had to be resected due to gangrene. The resection and anastomosis was done without any struggling or fighting as there was free and easy access to the peritoneal cavity thanks to the preperitoneal approach..
The strict transverse incision is placed 2-3 fingers above the pubis. The fascia is opened in the same transverse direction, splitting the oblique and transverse muscles. The rectus muscle is retracted medially. It is often necessary to cut its insertion in the pubic bone partially to get good access. Finger dissection opens up the preperitoneal space.
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The incarcerated femoral hernia sack is isolated and freed with finger dissection
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The hernia sack is reduced and opened, revealing gangrenous bowel.
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The gangrenous part of the small bowel is resected and anastomosed end-to end with a double layer of continuous suture of the non- or slow resorbable type.
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The peritoneum is closed (optional) and the hernia sack resected.
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