Appendix-sparing laparoscopic transabdominal preperitoneal hernioplasty for a De Garengeot's hernia. A new case report and review of the literature.

Int J Surg Case Rep

The University of the Basque Country, EHU/UPV, C/ Álava, 45, 01006, Spain; Department of General Surgery, University Hospital of Araba (HUA), Santiago Apóstol Hospital, Vitoria 01008, Spain.

Published: January 2024

Introduction and importance: More than 600 cases of De Garengeot's hernia, characterized by a femoral hernia containing the vermiform appendix, have been reported. The surgical method of choice has been an appendectomy and a primary hernia repair. Since the emergence of laparoscopy, this is undoubtedly an option. However, the treatment of the appendix remains in most reports as an appendectomy. Successful appendix-sparing treatment of De Garengeot's hernia via laparotomy or laparoscopy has been described, mainly since the COVID-19 pandemic. Case presentation: We report a new case of an 80-year-old woman with an incarcerated De Garengeot's appendiceal femoral-crural hernia, successfully treated entirely laparoscopically. She had noticed the protrusion of a lump in her right inguinal region for two months. Radiological studies, ultrasonography (US), and computed tomography (CT) were inconclusive. Due to the failure in the preoperative diagnosis, a minimally invasive endoscopic approach was performed. Although the distal appendix appeared incarcerated in the femoral ring, there was no evidence of appendicitis. Thus, a fully laparoscopic appendix-sparing transabdominal preperitoneal (TAPP) hernioplasty procedure was undertaken. The patient made an uninterrupted recovery. She did well postoperatively with no complications, left the hospital the same day in a stable condition, returned to complete activities, and has enjoyed good health since. Clinical Discussion: Our literature review shows that in selected cases an appendectomy may be safely avoided, eliminating appendectomy-associated morbidity, and could be considered the first-line alternative when expertise is available. Conclusion: A fully laparoscopic appendix-sparing TAPP approach seems safe and feasible to treat this entity.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10800759PMC
http://dx.doi.org/10.1016/j.ijscr.2023.109207DOI Listing

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