Laparoscopy in the evaluation of the incarcerated mass in groin hernia

In hernia patients, the preoperative diagnosis of strangulation is difficult. In this prospective study, we investigated the usefulness of an exploratory laparoscopy to evaluate the viability of a viscus incarcerated in a groin hernia.

Twenty-seven patients with an acute irreducible inguinal mass underwent exploratory laparoscopy. The hernia was reduced, and the viability of the incarcerated viscus was judged laparoscopically on the basis of color, congestion, and contractility.

Twenty-four hernias were found. In sixteen patients, the contents of the hernia were viable. In five patients, a necrotic bowel segment was found, and a laparotomy and resection were done. In three patients, no hernias were found. The cause of inguinal pain was spermatic cord hematoma in one patient and inguinal abscess in another; however, the cause of pain in the third patient remained unclear. After laparotomy, one patient developed a fascial rupture that required reoperation. There were no other complications.

At laparoscopy, the judgment of the viability of the contents of the hernia is similar to that at laparotomy. The early use of laparoscopy can prevent many unnecessary laparotomies.