A 2-stage laparoscopic repair of a strangulated femoral hernia

The patient was a 74-year-old woman who was examined in our hospital because of a chief complaint of abdominal pain. We made a diagnosis of right-sided strangulated femoral hernia and performed emergency surgery. Diagnostic laparoscopy revealed small bowel perforation as a result of Richter-type strangulation of the small bowel. The hernia sac was reflected and ligated, and we only performed small bowel resection through a minilaparotomy. The patient was temporarily discharged on postoperative day 7, and 30 days after the first-stage operation we repaired the hernia in the second stage by the transabdominal preperitoneal (TAPP) method. When mesh repair is used to treat cases of strangulated inguinal hernia associated with severe intraperitoneal contamination, there is concern about infection, and tissue suturing has been performed in the past. However, in view of the fact that, in addition to the small bowel perforation, the patient was taking an anticoagulant drug and that tissue suturing is followed by a higher rate of recurrence and chronic pain than the mesh method, we performed TAPP method in a 2-stage procedure. Because 2- stage laparoscopic hernia repair appeared to be a possible option for the treatment of strangulated inguinal hernias, we report this case.